神经内镜第三脑室底造瘘术治疗梗阻性脑积水及其术后颅内压的监测

目的探讨神经内镜第三脑室底造瘘术（ETV）治疗梗阻性脑积水的效果及其术后颅内压（ICP）监测的意义。方法采用ETV治疗梗阻性脑积水36例，其中术后行ICP动态监测9例。结果术后患者症状缓解33例（91．7％），复查头颅CT或MRI示脑室系统较术前缩小；3例（8.3％）肿瘤引起的梗阻性脑积水症状缓解不明显，改行脑室-腹腔分流术。本组无死亡病例。9例术后行ICP监测结果示：①ETV术后18h内平均ICP〈10mmHg，18h后平均ICP轻度上升，稳定于10-12mmHg之间，肿瘤引起的脑积水ICP上升较快；②4例单纯导水管梗阻性脑积水术后使用甘露醇，用药后1-2h ICP下降1-2mmHg，2h后ICP逐渐恢复至用药前水平。结论①ETV后18h内ICP稍低，可能与术中放出脑脊液过多有关，可暂不应用脱水药物；②肿瘤引起的梗阻性脑积水应积极治疗原发病变。

Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus and Postoperative Dynamic Monitoring of Intracranial Pressure

Objectives To explore the curative effect of endoscopic third ventriculostomy（ETV） on obstructive hydrocephalus and to observe postoperative dynamic change in the intracranial pressure （ICP） in the patients with obstructive hydrocephalus. Methods Thirty-six patients with obstructive hydrocephalus undergoing ETV, and ICP was monitored after the surgery in 9 patiens. Results In 33 patients （91.7%） the symptoms were relieved and CT or MRI showed that the cerebral ventricls shrank after ETV. In 3 patients （8.3%） with hydrocephalus caused by neoplasm ventriculo-peritoneal shunt was performed because their symptoms were not relieved after ETV. No patients died. Monitoring of ICP showed that①within 18 hours after ETV, the mean ICP is under 10 mmHg, more than 18 hours after ETV, the mean ICP in all the cases rised slightly and stabilized at 10-12 mmHg, and the ICP increased more quickly after ETV in the patients with obstructive hydrocephalus caused by neoplasm; ②in 4 patients with aqueduct obstructive hydrocephalus due to occlusion of aqueducts undergoing ETV, the ICP decreased by 1-2 mmHg within 1-2 hours after infusion of 20% mannitol, and then gradually rised to the level before the use of mannitol. Conclusions ①Within 18 hours after ETV, the slightly low ICP is related to the CSF over-releasing in the operation, and it temporarily is no necessary to use dehydrating agents. ② In the patients with Hydrocephalus caused by neoplasm the neoplasm should be resected as soon as possible.