摘要
目的 :从三脑室底部造瘘术的经验总结 ,提高梗阻性脑积水的疗效。方法 :1996年 1月至 1999年 12月 ,我科共实施立体定向三脑室底部造瘘术治疗梗阻性脑积水 19例。术前均作 MRI检查 ,鞍背与脑干之间距离大于5 m m,梗阻原因为导水管狭窄 14例 ,松果体区肿瘤 3例 ,三脑室后部肿瘤 2例。全部病例均在 L eksell- G型定向仪辅助下 ,MRI导向 ,应用德国生产的 Storz硬质神经内窥镜 ,由右额钻孔右侧侧脑室入路。根据术中内窥镜下脑室内解剖结构 ,参考立体定向靶点坐标及轨迹 ,选择造瘘口位置。造瘘口一般位于鞍背后方 ,两个乳头体前方 ,用单极电凝器电凝后 ,穿通之 ,再用球囊导管扩大造瘘口 ,直径在 6～ 8mm之间。结果 :全组病人造瘘成功 ,造瘘口未见出血。术后高颅压症状缓解明显。术后 1周颅脑 CT复查显示脑室系统缩小不明显 ,一个月后可见明显缩小 ,但是有1例病人术后二周不但未见缩小 ,反而有所扩大 ,再行 V— P分流术。全组无死亡率。结论 :立体定向辅助下内窥镜作三脑室底部造瘘术 ,具有定位准确 ,手术安全 ,疗效确切的特点。用单极电凝穿通三脑室底部及球囊导管扩张造瘘 ,瘘口形成可靠。
Objective:To elucidate the surgical indications and technique of stereotactic endoscopic third ventriculostomy(ETV),an analysis of 19 consecutive ETVs was conducted.Methods:Nineteen ETVs were perfomed from Jan.1996 to Dec.1999.Hydrocephalus were caused by aqueductal stenosis in 14 patients,pineal region tumors in 3,posterior third ventricular tumors in 2.All patients' pre-operative MRI showed the distance between posterior clinoidal process and brainstem was more than 5mm.Leksell-G frame,MRI scanning and Storz rigid neuroendoscope were employed.The approach to the third floor was right lateral ventricle through a burrhole in the right frontal bone.According to the ventricle anatomy under the endoscope and the coordinates trajecctory of the target,the hole was made on the third ventricular floor.It was made between posterior clinoidal process and mammillary bodies by a monopolar probe.After coagulation,the third ventricular floor was punctured and then the hole was enlarged by a balloon catheter.The hole diameter ranged from 6mm to 8mm.Results:All ETVs were accomplished without bleeding.18 patients's intracranial hypertension were relieved post-operatively.One patient underwent V-P shunt after ETV because of enlargement of ventricles on follow-up CT scanning film.There were no infection and permanent morbidities of mortalities.Conclusion:ETV with stereotactic guidance,monopolar probe puncture and balloon catheter enlargement is accuracy and safety during the hole making.ETV is still effective in 18/19 patients in our group.
出处
《立体定向和功能性神经外科杂志》
2000年第4期207-209,共3页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
梗阻性脑积水
三脑室底部造瘘术
立体定向术
Obstructive hydrocephalus,Endoscopic third ventriculostomy,Stereotaxy,Neuroendoscope
