神经内窥镜第三脑室底造瘘术治疗梗阻性脑积水

目的 探讨对梗阻性脑积水患者采用神经内窥镜下进行第三脑室底造瘘的手术方法．分析手术成功与失败的原因。方法梗阻性脑积水原因分别为第三脑室后部肿瘤5例，中脑顶板胶质瘤2例，Chiari畸形2例，另12例为不明原因引起的导水管梗阻或狭窄。同位素^99Tcm-TPA脑池显像显示为非脑脊液吸收障碍性阻塞性脑积水。神经内窥镜从侧脑室经蒙氏孔进入第三脑室，在乳头体前方第三脑室底最薄处造一瘘口与脚间池相通。结果术后随访12～26个月，所有患者脑积水症状均缓解，脑室体积缩小。结论神经内窥镜行第三脑室底造瘘治疗非脑脊液吸收障碍性脑积水是一种有效的微创手术。     

第三脑室底造瘘治疗梗阻性脑积水

目的：探讨对梗阻性脑积水患者采用在神经内窥镜下进行第三脑室底造瘘的手术方法。分析手术成功与失败的原因,方法：对21例不同原因造成的梗阻性脑积水患者进行了23次神经内视镜下的第三脑室底造瘘手术。结果：随访1-33个月,平均19个月,显效15例,有效2例,4例无效患者改行V-P分流术,2例接受2次造瘘;手术并发症包括颅内感染2例,严重硬膜下积液1例,暂时性脑疝1例,暂时性动眼神经麻痹1例,中脑及丘脑出血各1例,无死亡病例,结论：神经内窥镜下的第三脑室底造瘘对治疗梗阻性脑积水是一种安全、有效的手术方法,但为了提高手术疗效,减少手术并发症,应采用良好的手术器械、熟练掌握手术方法,选择适当手术患者。     

第三脑室底造瘘术和脑室腹腔分流术治疗梗阻性脑积水疗效分析

目的探讨神经内镜下第三脑室底造瘘术和传统脑室腹腔分流术治疗梗阻性脑积水的疗效优劣。方法梗阻性脑积水患者60例,随机进行神经内镜下第三脑室底造瘘术或脑室腹腔分流术,对两组患者术后主要并发症、治疗有效率及术后复发率进行对比,并对结果进行统计学分析。结果两组患者术后颅内感染、脑室内出血、气颅、硬膜下积液、慢性硬膜下血肿的发生率分别为0.0%和3.1%、7.1%和3.1%、3.6%和3.1%、0.0%和6.2%、0.0%和6.2%,两者比较无统计学差异。两组患者术后治疗有效率分别为89.3%和84.4%,两者比较无统计学差异。造瘘组患者术后复发率为3.6%,低于分流组的28.1%,两者比较有统计学意义。结论神经内镜下第三脑室底造瘘术治疗梗阻性脑积水术后主要并发症及治疗有效率和传统脑室腹腔分流术无明显差异,但复发率比脑室腹腔分流术低,值得临床推广应用。     

神经内镜下第三脑室底造瘘术治疗梗阻性脑积水

梗阻性脑积水是神经外科的常见疾病之一,因患者往往伴有不同程度的颅内高压症状,随着病程的迁延,直接影响患者的生活质量。本院自2008年5月至2009年2月共收治梗阻性脑积水患者17例,     

脑室镜三脑室底造瘘术治疗儿童梗阻性脑积水

目的探讨脑室镜三脑室底造瘘术(ETV)治疗儿童梗阻性脑积水的方法、术后并发症的成因及防治。方法我院2008-01—2014-01应用ETV治疗儿童梗阻性脑积水16例,分析手术方法及常见并发症的防治。结果 16例均获得良好效果,其中11例症状体征消失,脑室形态恢复正常,间质水肿消失;5例症状和(或)体征好转,脑室缩小及(或)间质水肿好转。术后短期发热6例,切口愈合不良2例,头皮下积液3例,颅内感染1例。结论严格控制梗阻性脑积水儿童ETV适应证,依据儿童三脑室底部解剖特点,选择个体化造瘘方法,术后早期腰穿放液,可明显减少手术并发症,提高手术质量。     

神经内镜下第三脑室底造瘘术治疗梗阻性脑积水的疗效观察

目的 探讨神经内镜下第三脑室底造瘘术（ETV）治疗梗阻性脑积水的疗效。方法 2013年5月至2015年5月ETV治疗梗阻性脑积水42例。结果 成功造瘘39例,因术中出血二期行脑室-腹腔分流术3例。术中出现心率减慢4例、造瘘口少量出血3例,术后短暂发热21例、可疑感染1例、头皮切口漏2例。术后随访3~36个月,平均（10.4±2.7）个月;改善36例（85.7%）,无改变4例（9.5%）,恶化2例（4.8%）。术后3个月复查CT或MRI显示:侧脑室缩小33例（78.8%）,侧脑室无明显变化但前角间质性水肿减轻5例（11.9%）,侧脑室无变化4例（9.5%）。结论 ETV治疗梗阻性脑积水效果较好,手术操作简单,安全系数高,并发症少。     

梗阻性脑积水经第三脑室底造瘘术后颅内压变化规律

目的回顾性总结经内镜第三脑室底造瘘术(ETV)治疗梗阻性脑积水的手术技巧、疗效及术后颅内压(ICP)的变化规律及动态ICP监护的价值。方法经内镜行ETV治疗梗阻性脑积水共146例,病因包括导水管狭窄98例、颅内肿瘤48例(第三脑室及松果体区肿瘤)。术后行动态ICP监护53例(导水管狭窄36例、肿瘤17例),平均监护时长96 h。结果随访8个月至6年,术后脑积水明显缓解或消失138例(94.5%),8例脑积水缓解不明显或无效(5.5%),改行脑室腹腔分流术。ICP监护显示:术后6 h内平均ICP明显下降,低于10 mm Hg,此后缓慢轻度上升,96 h稳定于12 mm Hg;单纯导水管狭窄性脑积水平均ICP上升较缓慢、波动较小,最后达到10 mm Hg;而肿瘤性脑积水上升较快、波动较大,最后达到15 mm Hg。并发症28例(19.2%):术后发热22例,双额部硬膜外血肿1例、切口脑脊液漏2例、脑室少量积血2例、硬膜下积液1例。本组无死亡。结论 1第三脑室底造瘘治疗梗阻性脑积水(尤其是导水管狭窄脑积水)安全、有效,应作为其首选治疗手段;2术后行ICP动态监护,不仅可监测颅内压的变化,判断手术是否有效,同时可以观察有无脑室继发性出血等并发症及指导术后用药。     

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。     

第三脑室造瘘术治疗梗阻性脑积水疗效分析

本院从1999年9月至2003年4月采用第三脑室造瘘术(endoscopic third ventriculostomy,ETV)治疗58例梗阻性脑积水患者.本文就ETV手术指征和疗效分析进行初步探讨.     

内窥镜下第三脑室造瘘术治疗梗阻性脑积水

梗阻性脑积水是神经外科的常见病、多发病之一,传统的治疗方法是行脑室-腹腔分流术,近几年经内窥镜行第三脑室造瘘已发展成为梗阻性脑积水的主要治疗方法。我科自1998年1月至2003年12月共收治梗阻性脑积水73例,报道如下:一、对象与方法1.一般资料:梗阻性脑积水患者73例,病因为:     

Simultaneous endoscopic third ventriculostomy and ventriculoperitoneal shunt for infantile hydrocephalus

Objective We analyzed a series of consecutive hydrocephalic infants treated with implantation of a ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) simultaneously. Materials and methods Between 1995 and 2006, we treated the 111 hydrocephalic infants. Among those patients, 31 infants underwent VPS and ETV simultaneously, and 45 patients underwent only VPS. The ETV plus VPS group had 17 males and 14 females with a mean age of 6.32 months. The VPS only group consisted of 25 males and 20 females with a mean age of 4.43 months. There was no difference in etiology of hydrocephalus or clinical characteristics between the two groups. We compared shunt effectiveness by calculating the pre- and postoperative ventricular index and shunt failure rates during the follow-up period between the two groups. The follow-up period ranged from 6 to 140 months (mean, 53.23 months) in the ETV plus VPS group and from 6 to 148 months (mean, 75.98 months) in the VPS only group. The success rate was 83.9% (26 of 31) in the ETV plus VPS group and 68.9% (31 of 45) in the VPS only group. There were three infections and two shunt obstructions in the ETV plus VPS group versus eight obstructions, five infections, and one overdrainage in the VPS group. The preoperative and postoperative ventricular ratio of both groups showed statistically significant change (P < 0.000). Conclusion This simultaneous procedure could be the first choice of action for the hydrocephalic patients less than 1 year old.     

神经内镜治疗脑积水

目的：探讨神经内镜在脑积水治疗中的作用。方法：采用神经内镜单独或辅助手术的方法,对111例患者行126次治疗。结果：随访3－34个月。第三脑室底脚间池造瘘术的54例导水管狭窄性脑积水45例（83％）有效。脉络丛凝固术的26例交通性脑积水20例（77％）有效。透明隔穿通术的6例单侧脑室积水均有效。内镜引导置管的40例次脑积水,分流管颅内端均通畅。并发症：术后体温发烧1－4天11例,颅内感染2例,硬膜下出血及积液2例。结论：神经内镜用于脑积水的治疗,明显改善手术疗效、降低并发症,可使部分患者免除体内置管之苦,应作为导水管狭窄性脑积水、进展缓慢的交通性脑积水及单侧脑室积水的首选治疗方法。对分隔型及其他类型脑积水,内镜应作为术中重要辅助工具。     

神经内镜下行三脑室底造瘘术治疗梗阻性脑积水的并发症分析和防治

目的:分析神经内镜下三脑室底造瘘术(ETV)的手术并发症原因,探讨其防治要点。方法:通过回顾性分析2004年9月至2006年2月应用ETV连续治疗梗阻性脑积水55例的手术并发症,对ETV的常见并发症的原因做了探讨。结果:54例患者ETV得以完成,术后50例患者恢复良好,脑积水症状明显减轻或消失。4例患者症状复发或加重,行脑室腹腔分流术。术后并发症包括硬膜下积液8例,发热15例,2例伴有脑膜刺激征为颅内感染,癫痫1例,硬膜外出血1例,头皮下积液8例。结论:熟悉三脑室底的解剖结构,选择合适的造瘘方法,并注意手术前后脑脊液动力学的变化,可以减少三脑室底造瘘治疗梗阻性脑积水的手术并发症。     

立体定向内窥镜下三脑室底部造瘘术

目的：从三脑室底部造瘘术的经验总结,提高梗阻性脑积水的疗效。方法：１９９６年１月至１９９９年１２月,我科共实施立体定向三脑室底部造瘘术治疗梗阻性脑积水１９例。术前均作ＭＲＩ检查,鞍背与脑干之间距离大于５ｍｍ,梗阻原因为导水管狭窄１４例,松果体区肿瘤３例,三脑室后部肿瘤２例。全部病例均在Ｌｅｋｓｅｌｌ－Ｇ型定向仪辅助下,ＭＲＩ导向,应用德国生产的Ｓｔｏｒｚ硬质神经内窥镜,由右额钻孔右侧侧脑室入路。根据术中内窥镜下脑室内解剖结构,参考立体定向靶点坐标及轨迹,选择造瘘口位置。造瘘口一般位于鞍背后方,两个乳头体前方,用单极电凝器电凝后,穿通之,再用球囊导管扩大造瘘口,直径在６、～８ｍｍ之间。结果：全组病人造瘘成功,造瘘口未见出血。术后高颅压症状缓解明显。术后１周颅脑ＣＴ复查显示脑室系统缩小不明显,一个月后可见明显缩小,     

脑室镜下三脑室底造瘘术治疗非交通性脑积水

目的探讨脑室镜下第三脑室底造瘘术方法。方法回顾性分析2001～2005年行脑室镜下第三脑室底造瘘术的30例非交通性脑积水患者临床资料。结果30例患者近期疗效满意,1例症状复发改行脑室-腹腔分流术,无严重并发症。结论脑室镜下第三脑室底造瘘术可迅速有效地改善症状,脑脊液通过瘘孔进入生理性循环,可避免感染和过度分流,且安全可靠。     

Endoscopic third ventriculostomy associated 3D-construcive inference steady state MRI for obstructed hydrocephalus: A retrospective study

Background

Endoscopic third ventriculostomy (ETV) is a developing therapeutic stratagem for obstructive hydrocephalus (OH). The aim of this study was to determine the relevance of third ventricle diagnostic imaging by three-dimensional constructive inference in steady state (3D CISS) MRI in patients with OH and to access the preoperative and postoperative values of this technique in patients undergoing endoscopic third ventriculostomy (ETV).

Methods

Forty-six patients with an existing obstruction below the posterior part of the third ventricle underwent 3D CISS sequence MRI on a 1.5 T superconductive MR scanner and were included into this retrospective study. 19 patients were treated with ETV. Regression analysis of the correlation between third ventricle enlargement (TVE) and hydrocephalus degree (HD) and between TVE and third ventricle floor thickness (TVFT) was calculated. In the 19 ETV cases the incisions were marked according to MR images, and the 3D-CISS sequence imaging and the surgical outcome were compared before and after ETV.

Results

By virtue of 3D-CISS 97.83% third ventricle floors and 91.30% basilar arteries (BA) could be visualized, and there was a positive correlation between TVE and HD and a negative correlation between TVE and TVFT in this group. All incision sites on the scalp could be marked correctly. The degree of enlargement of the third ventricle allowed a prediction of the technical challenge to puncture the third ventricle floor. The position and route of BA could be demonstrated avoiding intraoperative iatrogenic lesions. At follow-up, 100% of the fistulas of the third ventricle floor could be measured on 3D-CISS images. The mean diameter of the fistulas was 6.12 ± 0.96 mm; in 91.67%, new CSF fluid directions could be demonstrated; in 83.33%, enlarged ventricle system got withdrawn, and 91.67% patients showed relief of initial symptoms. 1 patient needed the implantation of a ventriculoperitoneal shunt 7 months after EVT. The preoperative HD compared with postoperative HD (P < .01); the preoperative TVE compared with postoperative TVE (P < .05).

Conclusion

Images of the 3D-CISS sequence on MRI can visualize the third ventricle accurately and provide a reliable method for the evaluation of ETV pre- and postoperatively. The degree of enlargement of the third ventricle in patients with obstructive hydrocephalus is associated with the thickness of third ventricle floor and allows a prediction of the difficulty to puncture in ETV.     

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。