脑室镜下手术治疗梗阻性脑积水的临床研究

目的探讨脑室镜在梗阻性脑积水中的治疗方法和临床效果。方法选择2008-06~2010-04间,采用脑室镜下行第三脑室造瘘术治疗梗阻性脑积水17例病例,术前均行头部CT、MRI显像检查。结果 17例造瘘成功。7例手术后发热,1例手术后6个月发生双侧慢性硬膜下血肿(经钻孔引流后痊愈),1例术后6个月手术侧发生硬脑膜下积液(因无特殊不适,予以随访观察)。随访2~20个月,17例手术后临床症状均缓解。17例造瘘术后7 d颅内压显著下降,复查CT、MRI示:7例侧脑室体部横径较术前缩小,平均缩小2.3(0.7~4.6)mm;3例侧脑室大小无变化。本组17例侧脑室旁水肿均消失。1例术前合并小脑扁桃体下疝者手术后7 d复查MRI,见:下疝的小脑扁桃体向上移位4.0 mm。结论脑室镜手术是治疗梗阻性脑积水的安全、有效的方法 。

Clinical Research of Ventriculoscope Surgery to Treat Obstructive Hydrocephalus

Objective To discuss the treatment and the clinical effect of obstructive hydrocephalus Ventriculoscope.Methods From June 2008 to April 2010,17 cases of such patient were underwent third ventriculostomy treatment of obstructive hydrocephalus fistula postoperatively,head CT、MRI imaging examination were all taken.Results 17 cases were made fistula after surgery,7 cases of fever,1 case 6 months after surgery bilateral chronic subdural hematoma（after recovery by drilling drainage）,1after 6 months operation side subdural effusion（because there was no particular discomfort to follow-up）.Follow-up 2 ~ 20 months after surgery,17 cases were alleviate clinical symptoms.17 after seven days of intracranial pressure decreased significantly,review of CT,MRI,7 cases of lateral ventricle body of width,on average,than preoperative 2.3 mm（0.7~4.6 mm）,3 cases of lateral ventricle without changing the size,17 cases were beside the lateral ventricle edema.1 case before operation under the hernia surgery cerebellar tonsillar 7 days after the review of MRI seen hernia cerebellar tonsillar upward migration 4.0 mm.Conclusion Ventriculoscope treatment of obstructive hydrocephalus might be safe and effective method.