神经内镜下第三脑室底造瘘术治疗脑积水的临床效果

正目前,第三脑室底造瘘术是梗阻性脑积水的首选治疗方法~([1])。神经内镜下第三脑室底造瘘术(endoscopic third ventriculostomy,ETV)损伤小,并发症少。随着对于脑积水发病机制研究的不断加深和神经内镜技术的不断成熟,EVT逐渐应用于一些特殊类型的脑积水治疗,并且取得令人满意的效果。1 ETV治疗脑积水长期随访效果目前,ETV治疗脑积水的报道越来越多,但大多数只报道近期缓解率,远期缓解率的报道相对较     

神经内镜下第三脑室底造瘘术治疗非交通性脑积水（附37例分析）

目的总结神经内镜下第三脑室底造瘘术治疗非交通性脑积水的经验。方法对37例非交通性脑积水病人行神经内镜下第三脑室底造瘘术，随访12-36个月。结果35例病人术后症状明显缓解，且无明显并发症，2例无效者改行脑室-腹腔分流术后症状缓解。结论神经内镜下第三脑室底造瘘术治疗非交通性脑积水是一种微创、有效、术后恢复快、并发症少的手术方法。     

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,     

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。     

内镜下行第三脑室底造瘘术治疗脑室炎后慢性脑积水

目的 探讨应用神经内镜在治疗慢性复杂脑积水的效果.方法 回顾性分析了15例用神经内镜行第三脑底造瘘术并脑室冲洗治疗的慢性复杂脑积水的病人资料.结果 15病人获得良好的效果,无并发症发生,1例病人术后15 d,脑积水复发,冉次行第三脑底造瘘时发现造瘘口闭合,二次造瘘后恢复良好.结论 神经内镜行第三脑底造瘘术并脑室冲洗治疗慢性复杂脑积水的病人有确实效果.     

神经内镜技术第三脑室底造瘘术治疗脑积水的进展

神经内镜技术在治疗脑积水方面发挥着重要而不可或缺的作用。在神经内镜技术中尤以第三脑室底造瘘术在治疗脑积水中最常见。本文阐述了第三脑室底造瘘术在治疗脑积水传统适应证——非交通性脑积水中的应用,同时也回顾了近些年该项技术在交通性脑积水和小儿脑积水中的应用进展。     

内镜下第三脑室底造瘘治疗小儿梗阻性脑积水临床分析

目的提高经脑室镜第三脑室底造瘘术治疗小儿梗阻性脑积水的临床效果。方法回顾性分析新乡医学院第一附属医院神经外科2013—2017年采用经脑室镜第三脑室底造瘘术治疗梗阻性脑积水26例小儿(12岁)患者的临床资料,观察临床效果。结果 20例患儿疗效满意,6例症状无进行性加重,无严重并发症。结论经脑室镜第三脑室底造瘘术能够迅速有效改善患儿临床症状,效果满意,安全可靠。     

脑室镜第三脑室底造瘘治疗非交通性脑积水54例分析

目的探讨脑室镜第三脑室造瘘(ETV)治疗非交通性脑积水的疗效。方法回顾性分析54例非交通性脑积水病人的临床资料,均行ETV治疗,根据随访结果对ETV疗效进行客观的临床评估。结果成功实施ETV52例,造瘘失败2例。对成功实施ETV的病例随访3～39个月,有效44例;无效8例,均改行脑室-腹腔分流术。术后未见严重并发症和死亡病例。结论ETV治疗非交通性脑积水具有微创、疗效好、手术时间短、并发症少及康复快等优点,可作为首选治疗。     

内镜下第三脑室底造瘘术治疗松果体区肿瘤引起的梗阻性脑积水

目的 探讨内镜下第三脑室底造瘘治疗松果体区肿瘤导致的梗阻性脑积水的手术技巧及手术效果。方法 回顾性分析2013年3月至2014年6月采取内镜下第三脑室底造瘘术治疗的22例因松果体区肿瘤引起的梗阻性脑积水的临床资料。结果 术中发生少量出血3例,少量颅内积气4例;术后出现短暂性发热6例。无手术死亡及严重后遗症。22例术后随访3~24个月,手术有效18例（81.8%）;无效4例,均改行脑室-腹腔分流术。结论 内镜下第三脑室底造瘘术具有微创性,术后并发症少,是松果体区肿瘤引起的梗阻性脑积水的有效治疗方法。     

神经内镜第三脑室造瘘术治疗梗阻性脑积水32例临床分析

最近几年,随着影像学技术、内窥镜器械的进步,显微解剖研究有了进一步提高,第三脑室底部造瘘术（ETV）成为神经外科治疗梗阻性脑积水的一种重要方法[1]。自2005年以来,我科应用硬性神经内镜行第三脑室造瘘手术治疗梗阻性脑积水32例,取得较好疗效。现报道如下。     

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。     

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。     

第三脑室底造瘘术治疗梗阻性脑积水与分流术的疗效比较

目的 比较梗阻性脑积水的两种手术方法的疗效及并发症。方法 采用经神经内镜第三脑室底造瘘术治疗梗阻性脑积水35例，脑室腹腔分流术治疗梗5且性脑积水63例。结果 造瘘组：平均用时35min，症状缓解34例(97.1％)，复发1例(2．9％)，并发症3例(8.6％)，为非感染性发热；分流组：平均用时78min，症状缓解63例(100％)，复发16例(25．4％)，并发症18例(28．6％)，为分流管堵塞、感染、颅内血肿及分流管外露等。两组均无死亡。结论 经神经内镜第三脑室底造瘘术治疗梗5且性脑积水较脑室腹腔分流术的疗效相当，并发症及复发率明显降低，手术时间缩短，应作为梗阻性脑积水的首选治疗方法。     

Ventricular anatomy of hydrocephalus associated with myeloschisis and endoscopic third ventriculostomy

Objects To characterize the anatomical features of the ventricular regions in patients with myeloschisis and related to successful performance of endoscopic third ventriculostomy (ETV). Methods Radiological and endoscopic findings of 21 myeloschisis patients were retrospectively reviewed. Radiological features that could interfere with endoscopic procedures were (1) a huge massa intermedia (12/19), (2) sloping of the third ventricular floor (3/10), (3) narrow anteroposterior length of the third ventricular floor (2/10), and (4) narrow prepontine cistern (8/21). Endoscopic findings were (a) a narrow foramen of Monro (0/3), (b) hypertrophy of the anterior commissure (1/3), (c) sloping of the third ventricle floor (1/3), (d) a huge massa intermedia (3/3), and (e) opaque third ventricular floor (3/3). These endoscopic findings did not interfere with endoscopic procedures by using the Oi-HandyPro neuroendoscope without the above-mentioned radiological features 3 or 4. Conclusion Narrow anteroposterior length of the third ventricular floor and narrow prepontine cistern are not infrequently observed. Preoperative evaluation and intraoperative inspection of these findings are very important in successful performance of ETV.     

三脑室底造瘘术中的心率变化

目的 了解神经内镜下三脑室底造瘘术过程中心率变化情况.方法 分析35例三脑室底造瘘术患者的病历资料,根据麻醉记录单计算三脑室底造瘘术中每5min心率变化情况,计算其斜率和心率变化幅度,对照手术录像观察心率变化与手术操作间的关系.结果 35例患者中,11例患者术中出现快速的心率变化,斜率绝对值大于0.79,其中4例发生心动过速,2例发生心动过缓,6例快速心率变化发生于手术造瘘时,其中4例患者发生快速心率下降前没有明显心率上升改变;另5例发生于脑室冲洗止血过程中,所有患者中除1例心动过缓需要阿托品纠正,其余患者操作结束后自行缓解.结论 ETV术中快速心率变化比较常见,与快速冲洗脑室所致的颅内压升高和造瘘时三脑室底机械刺激有关,术中结合麻醉监测有助于提醒手术医师进行合理的手术操作,避免严重心律失常的发生.     

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.     

Complications of endoscopic third ventriculostomy

OBJECTS: Although endoscopic third ventriculostomy (ETV) is considered as the first choice in the management of noncommunicating hydrocephalus, it is not without risk or complication. METHODS: The patients who had undergone ETV only between 1998 and 2005 were retrospectively reviewed. There were 85 males and 70 females, and 173 ETVs were performed in 155 patients. The patients' age ranged from 2 months to 77 years. Complications were categorized as (1) intraoperative, (2) early postoperative (<1 month), and (3) late postoperative (>1 month). Follow-up of the patients ranged from 1 to 86 months. RESULTS: Overall complication rate per patient was 15.4%, and complication per procedure was 18%. Complication rate significantly varied with the etiology of hydrocephalus (P = 0.013). The patients with Chiari type I malformation and tumor had no or very low complication rates. The complication risk was significantly higher in repeat endoscopic procedure (55.5%) than in the first procedure (10%; P = 0.0001). CONCLUSION: ETV should be the first choice in the management of noncommunicating hydrocephalus. Training, experience, and meticulous technique will decrease the complication rate. Patients undergoing ETV should be followed in a similar manner to patients with cerebrospinal fluid shunts.     

Endoscopic third ventriculostomy in obstructed hydrocephalus

Forty-three ETV were performed in 46 patients of obstructive hydrocephalus. Study was divided into two groups. Group 1 was with 29 children of less than two years age. Group 2 had seventeen patients of more than 2 years, adolescent and adults. Group 1 had 70% clinical and 63% radiological improvement whereas Group 2 showed 100% clinical and 73% radiological improvement. ETV failed in relieving the symptoms of hydrocephalus in eight patients. They were eventually benefited with VP Shunt. There was one postoperative death, which was not related to the procedure. ETV is an important alternative to VP Shunt in relieving hydrocephalus due to obstruction in CSF pathway.     

Spontaneous third ventriculostomy in chronic obstructive hydrocephalus

Introduction Spontaneous ventriculostomy is a rare condition, and only few cases are reported. Cine magnetic resonance imaging can demonstrate the flow from the ventriculostomy. Case report A 25-year-old woman with a known tectal glioma and hydrocephalus was proved to have spontaneous third ventriculostomy.