脑室镜三脑室造瘘术治疗小儿阻塞性脑积水

目的分析本组49例病例，就手术病种和年龄的选择、手术方法及技巧做一介绍。方法全组49例，年龄1个月-18岁，平均33个月。CT、MRI及^99Tc^m-DTPA证实为脑脊液吸收功能正常的阻塞性脑积水。手术方法为经侧脑室、室间孔、三脑室置入神经内镜，于三脑室底与脚间池造一瘘孔。结果术后随访半年-5年，39例有好转；10例因无改善于术后3个月再行脑室腹腔分流手术，术后脑脊液漏3例，未有出血、感染及神经功能损伤等并发症。结论脑室镜三脑室底脚间池造瘘适用于脑脊液吸收功能正常的阻塞性脑积水。脑脊液吸收功能判断需靠同位^99Tc^m-DTPA检查。继发性脑积水治疗效果好于原发性脑积水，大龄儿童效果好于婴幼儿。

Endoscopic third ventriculostomy in treating children hydrocephalus

Objective Endoscopic third ventriculostomy has been shown to be a sufficient alternative in the surgical treatment of hydrocephalus. To elucidate indication and surgical technique, 49 cases were analyzed. Methods 49 patients were operated. Their age ranged from 1 month to 18 years (mean age: 33months). CT, MRI and 99Tcm-DTPA showed obstructive hydrocephalus and cerebral spinal fluid (CSF) absorption was normal. The technique is inserting endoscope through the foramen of Monro into the third ventricle, then perforating the floor of the third ventricle. Results The period of follow up was 6 months to 5 years. 39 patients exhibited improvements including clinical signs or ventricle sizes. 10 cases failed. 3 cases had CSF leakage postoperatively. There were no bleeding, infection and neurologic complications. Conclusion Third ventriculo-stomy is safe, effective and less complicating. The indication of endoscopic third ventriclostomy is occlusive hydrocephalus whose CSF absorption is normal. Radionuclide cisternography which was performed with 99Tcm-DTPA can reveal CSF absorption. The results of secondary hydrocephalus were better than those of primary hydrocephalus. Older children with hydrocephalus had better results than younger infants.