神经内镜治疗导水管梗阻性脑积水12例临床经验

目的 总结神经内镜下手术治疗12例导水管水平梗阻性脑积水的初步体会。方法 12例脑积水患中导水管水平阻塞为原发性10例，继发于顶盖区肿瘤2例。均采用神经内镜经侧脑室额角入路，经室间孔行三脑室底脚间池造瘘。结果 12例患造瘘术过程顺利，术中术后并发症少而轻，12例中术后3个月已随访的患9例，7例有效，2例无效。结论 神经内镜是治疗导水管梗阻性脑积水的有效手段，近期疗效满意。术中应针对三脑室底不同的特点采用适当的造瘘方法．随访应以确定颅内压是否正常、症状是否消失作为判断疗效的主要依据。

Experience with neuroendoscopic treatment of 12 patients with obstructive hydrocephalus due to aqueduct lesions]

OBJECTIVE: To review our experience in the treatment of hydrocephalus caused by aqueduct obstruction with neuroendoscopic third ventriculostomy. METHOD: Of the 12 patients with hydrocephalus, 10 had primary aqueduct obstruction with the other 2 suffering the obstruction secondary to tectal tumors. In all the cases the neuroendoscope was advanced into the third ventricle via the frontal horn and foramen of Monro, followed by third ventriculostomy to achieve free communication between the third ventricle and interpeduncular cistern. RESULTS: All the procedures were successful and smooth, with only occasional mild intra- and post-operative complications. Nine of the 12 patients were followed up 3 months after the operation, and 7 were found with good therapeutic effect while 2 failed to respond favorably. CONCLUSIONS: Neuroendoscopic third ventriculostomy is effective for hydrocephalus due to aqueduct obstruction, and may yield satisfactory short-term results. Different techniques of fenestration should be used to suit the individual-specific conditions of the third ventricle floor. In the follow-up of the patients, evaluation of the intracranial pressure and the patients' symptoms constitutes the main basis for assessment of the clinical results.