腔内多普勒微血管扫描在三脑室底造瘘术中的意义

目的探讨多普勒微血管探头超声检查在内镜三脑室底造瘘术治疗脑积水中的意义。方法完成27例梗阻性脑积水三脑室底造瘘术，术中均使用多普勒微血管探头抵达三脑室底部，行超声探测，监测基底动脉的走向、血流速度，进行术中实时定位，造瘘前后记录血管的多普勒超声图像。结果27例造瘘术前后基底动脉的管径、血流速度无变化，无血管损伤并发症。术后18例(66．67％)影像学证实扩大的脑室术后有回缩；半年后症状缓解23例(85．19％)，4例无效(14．81％)，其中2例行脑室腹腔分流术。无手术死亡或残疾。结论多普勒微血管探头超声检查在三脑室底造瘘术中的应用，可减少血管损伤类并发症的发生，有利于造瘘点准确定位，并能实时监测基底动脉的血流动力学变化，确保造瘘过程安全精确。

Usefulness of intra-cavity microvascular Doppler sonography in endoscopic third ventriculostomy

Objective To evaluate the usefulness of intraoperative microvascular Doppler sonography(MDS) in endoscopic third ventriculostomy(ETV). Methods Neuroendoscopic third ventriculostomy was completed on 27 obstructive hydrocephalus patients. In these cases, Doppler microvasculer probe was inserted in the bottom of third ventricle through endoscopic work channel for ultrasonography, such as inspecting speed and blood stream direction of basal artery, and perform real-time view and register ultrasonic scan image were conducted before and after fenestration. Results In all the cases, diameter and velocity of basal artery had no alteration before or after fenestration and no vascular injury complications. The enlarged brain ventricles of 18 in 27 patients(66.67%)were contracted by image inspecting; half year after operations, the symptoms of 23 patients((85.19)%) were improved, 4 patients((14.81)%) had no change, 2 patients had to accept ventriculoperitoneal shunt operations. Mortality as well as disability after the operation was zero. Conclusions Use of MDS in ETV is able to inspect the important blood vessel through the endoscopic canal, to reduce the complications of blood vessel injury effectively, and to locate puncturing fenestrations. MDS during operation can increase security and accuracy of puncturing bottom of third ventricle.