Schroeder H W, Gaab M R
Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
Neurosurgery. 1999 Sep;45(3):508-15; discussion 515-8. doi: 10.1097/00006123-199909000-00020.
The purpose of this study was to determine the safety and efficacy of endoscopic aqueductoplasty in patients with hydrocephalus caused by aqueductal stenosis. The controversy of third ventriculostomy and aqueductoplasty is discussed.
A series of 17 patients who underwent endoscopic aqueductoplasty is reported. Rigid rod-lens scopes were used for inspecting the aqueductal entry and performing balloon aqueductoplasty. With the aid of a 2.5-mm flexible endoscope, the aqueduct and fourth ventricle were explored and aqueductal membranous obstructions were perforated. Third ventriculostomies were performed simultaneously in nine patients. One aqueductal stent was inserted. In six patients, frameless computerized neuronavigation was used for an accurate approach to the aqueduct. The average duration of the endoscopic procedures was 59 minutes (range, 25-100 min).
There was no endoscopy-related mortality. Surgical complications included an asymptomatic fornix contusion and two injuries to the aqueductal roof, which resulted in permanent diplopia due to dysconjugate eye movement (one patient) and transient trochlear palsy (one patient). In addition, two patients developed transient dysconjugate eye movements, and one patient had an asymptomatic epidural hematoma. Eleven patients showed improvement in their symptoms. The conditions of five patients were unchanged. One patient died of stroke 1 month after the operation. No patient required shunting. The ventricles decreased in size in nine patients and were unchanged in the remaining eight patients.
Endoscopic aqueductoplasty is an effective alternative to third ventriculostomy for the treatment of hydrocephalus caused by short aqueductal stenosis. However, longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.
本研究旨在确定内镜下导水管成形术治疗导水管狭窄所致脑积水患者的安全性和有效性。并讨论第三脑室造瘘术和导水管成形术的争议。
报告了一组17例行内镜下导水管成形术的患者。使用硬杆状透镜内镜检查导水管入口并进行球囊导水管成形术。借助2.5毫米柔性内镜，探查导水管和第四脑室并打通导水管膜性梗阻。9例患者同时进行了第三脑室造瘘术。植入了1个导水管支架。6例患者使用了无框架计算机化神经导航以精确到达导水管。内镜手术的平均时长为59分钟（范围25 - 100分钟）。
无内镜相关死亡病例。手术并发症包括1例无症状穹窿挫伤和2例导水管顶部损伤，其中1例因眼球运动失调导致永久性复视，另1例导致短暂性滑车神经麻痹。此外，2例患者出现短暂性眼球运动失调，1例患者有无症状硬膜外血肿。11例患者症状改善。5例患者病情未变。1例患者术后1个月死于中风。无患者需要分流。9例患者脑室缩小，其余8例患者脑室大小未变。
内镜下导水管成形术是治疗短段导水管狭窄所致脑积水的一种有效替代第三脑室造瘘术的方法。然而，需要更长的随访期来评估导水管成形术后导水管的长期通畅情况。
