内镜下脑积水的手术治疗(附32例报告)

目的 评价神经内镜对脑积水的治疗作用。方法 回顾性分析内镜下行不同治疗方式的32例不同类型脑积水患者的临床资料。结果 随访3月～2年，9例梗阻性脑积水采用内镜下脑室造瘘术(7例行三脑室底造瘘术即ETV，2例行透明隔造瘘)，8例治疗有效，1例ETV后脑积水无明显改善，改行脑室腹腔分流术(V-P分流)；23例交通性脑积水采用内镜下引导V-P分流(10例)或内镜下引导V-P分流加内镜下脑室造瘘术(12例行ETV，1例行透明隔造瘘)，脑积水均获得改善。结论 梗阻性脑积水采用神经内镜脑室造瘘术，交通性脑积水采用内镜引导V-P分流或内镜引导V-P分流加脑室造瘘术，均可获得满意疗效。

Neuroendoscopic Surgery for Hydrocephalus (Report of 32 Cases)

Objective To study the role of neuroendoscopy in the treatment of hydrocephalus. Methods A retrospective study was performed on the clinical data of 32 patients with various types of hydrocephalus subject to various surgical procedures under the neuroendoscopy. Results A follow-up of 3 months to 2 years was performed. Nine cases of obstructive hydrocephalus underwent neuroendoscopic ventriculostomy. Among them, 7 cases were subjected to neuroendoscopic third ventriculostomy (ETV) and the remaining 2 cases of monoventricular hydrocephalus to fenestration of septum pellucidum under the neuroendoscopy. The satisfactory results were obtained in 8 cases. One case was failed and then treated by ventriculoperitional shunt (V-P shunt). Twenty-three cases of communicating hydrocephalus were subjected to V-P shunt (10 cases) or V-P shunt plus ventriculostomy (12 cases undgoing ETV, one case canalization of septum pellucidum under the endoscopy). The conditions of hydrocephalus in 23 patients were all improved. Conclusion Treatment of obstructive hydrocephalus by neuroendoscopic ventriculostomy and that of the communicating hydrocephalus only with V-P shunt guided by endoscopy or in combination with endoscopic ventriculostomy can obtained satisfactory results.