Morota N, Watabe T, Inukai T, Hongo K, Nakagawa H
Department of Neurological Surgery, Aichi Medical University, Nagakute-cho, Aichi-gun, Aichi 480-1195, Japan.
J Neurol Neurosurg Psychiatry. 2000 Oct;69(4):531-4. doi: 10.1136/jnnp.69.4.531.
Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the floor of the third ventricle, which may be important when performing endoscopic third ventriculostomy. Two middle aged patients with symptomatic longstanding hydrocephalus had scans that showed ventricular hydrocephalus, an empty sella, and a dilated infundibular recess which herniated into the sella turcica. Endoscopic third ventriculostomy confirmed that instead of the tuber cinerum and infundibular recess, the anterior inferior floor of the third ventricle was hanging down ventral to the pons into the sellar floor. Third ventriculostomy to the prepontine cistern was made on the dorsal wall of the dilated infundibular recess to the area surrounded by the dorsum sellae, the basilar artery trunk, and the left superior cerebellar artery, with good symptomatic control. Association of the empty sella and persistence of the infundibular recess must be carefully evaluated by MRI before attempting endoscopic third ventriculostomy. Herniation of the anterior inferior floor of the third ventricle into the empty sella can lead to loss of anatomical landmarks that require special attention during third ventriculostomy.
长期脑积水和颅内压升高可导致第三脑室底部出现异常的解剖变异，这在进行内镜下第三脑室造瘘术时可能很重要。两名有症状的长期脑积水中年患者的扫描显示脑室积水、空蝶鞍和扩张的漏斗隐窝，该隐窝疝入蝶鞍。内镜下第三脑室造瘘术证实，第三脑室前下壁不是灰结节和漏斗隐窝，而是垂在脑桥腹侧并进入蝶鞍底部。在扩张的漏斗隐窝后壁向鞍背、基底动脉干和左上小脑动脉所包围的区域进行至脑桥前池的第三脑室造瘘术，症状得到良好控制。在尝试内镜下第三脑室造瘘术之前，必须通过MRI仔细评估空蝶鞍与漏斗隐窝持续存在的关联。第三脑室前下壁疝入空蝶鞍可导致解剖标志丧失，这在第三脑室造瘘术期间需要特别注意。
