脑脊液循环通路上囊肿导致梗阻性脑积水的内镜治疗

目的 探讨由脑脊液循环通路上囊肿所致的梗阻性脑积水的内镜手术方法和技术要点.方法 对30例脑脊液循环通路上囊肿所致的梗阻性脑积水患者术前术后均行磁共振脑脊液电影成像检查,并行内镜手术治疗.其中包括脑室内囊肿11例(侧脑室囊肿7例,第四脑室囊肿4例),鞍上池囊肿4例,四叠体池囊肿1例,Dandy-Walker畸形6例,后颅窝蛛网膜囊肿8例.结果 术后所有患者脑脊液循环动力学都存在不同程度的改善,行三脑室底造瘘术的患者造瘘口均有脑脊液通过.有9例脑室内囊肿,4例鞍上池囊肿,1例四叠体池囊肿,4例后颅窝囊肿术后缩小.无手术相关的严重并发症及死亡病例,随访期间无囊肿扩大及造瘘口堵塞病例.结论 脑脊液循环通路上囊肿所致的梗阻性脑积水是神经内镜手术的最佳适应证.除了部分切除囊肿,还需行三脑窜底造瘘重建脑脊液循环,提高脑组织顺应性.术前应根据Cine MRI和同位素脑池显像结果综合分析其脑脊液循环动力学变化及脑脊液的吸收情况,确定手术方案.

Endoscopic therapy for obstructive hydrocephalus caused by cysts in the pathway of CSF circulation

Objective To explore the process and technique of neuroendoscopie operation to treat obstructive hydrocephalus caused by cysts located in the pathway of CSF circulation.Methods The cine MRI examinations and endoscopic operations were taken to treat 30 cases with obstructive hydrocephalus.Among all the cases,there are 11 intraventricular cysts(8 latera]yentricular cysts,4 fourth ventricular cysts),4 suprasellar arachnoid cysts,1 quadrigeminal cistern arachnoid cyst,6 Dandy-Walker malformations and 8 posterior fossa arachnoid cysts.Results CSF dynamic of all patients improved to difierent extents post-operation.It Was observed that CSF passed through the stoma after ETV in all patients.The volume of 9 intraventricular cysts,4 suprasellar arachnoid cysts,1 quadrigeminal cistern arachnoid cyst and 4 posterior fossa arachnoid cysts diminished for different degrees.There were no surgery-related serious complications or deaths.There were not cyst enlarged and stoma obstructed cases.Conclusions Obstructive hydrocephalus caused by cysts in the pathway of CSF circulation is the optimal indication for neuro-endoscopic surgery.After reseeting cyst partially,we should take the endoscopic third ventriculostomy to rebuild the paasway of CSF and elevate the cranial compliance.Cine MRI and radionuclide cistemography are helpful to undemtand the CSF dynamic and absorption.