Hayashi N, Hamada H, Hirashima Y, Kurimoto M, Takaku A, Endo S
Department of Neurosurgery, Faculty of Medicine, Toyama Medical & Pharmaceutical University, Sugitani, Japan.
Minim Invasive Neurosurg. 2000 Dec;43(4):181-6. doi: 10.1055/s-2000-11377.
The aim of this study was to clarify the clinical features of patients at risk of secondary obstruction following endoscopic fenestration. Clinical notes and endoscopic findings for 15 patients treated with endoscopic procedures were retrospectively reviewed. Endoscopic third ventriculostomy (ETV) was performed as initial treatment in 4 patients with non-communicating hydrocephalus, including a neonate with myelomeningocele, and as an alternative to shunt revision in 4 patients. Two patients with non-communicating hydrocephalus caused by tumor or arachnoid cyst were also managed with third ventriculostomy. Four patients with loculated hydrocephalus underwent endoscopic septostomy. A child with an isolated fourth ventricle was treated with endoscopic aqueductoplasty. Of the 15 patients undergoing endoscopic procedure, 4 required reoperation. Of the 10 patients treated with ETV, only the neonate with myelomeningocele required a ventriculoperitoneal shunt because of failure of the initial procedure. Of the 4 patients treated with endoscopic septostomy, 2 children with loculated hydrocephalus following intraventricular hemorrhage (IVH) underwent a second septostomy. In a patient with an isolated fourth ventricle following posthemorrhagic hydrocephalus, recurrence was noted 8 months after the initial procedure. He underwent a second procedure using a stent implanted into the aqueduct to maintain CSF circulation. Sufficient stomal size or implantation of a stent may be required in the under-2-year age group with hydrocephalus accompanied by IVH and associated with myelomeningocele, in whom the risk of secondary obstruction may be high.
本研究的目的是阐明内镜开窗术后继发梗阻风险患者的临床特征。对15例行内镜手术治疗患者的临床记录和内镜检查结果进行回顾性分析。4例非交通性脑积水患者，包括1例患有脊髓脊膜膨出的新生儿，将内镜下第三脑室造瘘术（ETV）作为初始治疗；4例患者将其作为分流修复术的替代方法。另外2例由肿瘤或蛛网膜囊肿引起的非交通性脑积水患者也接受了第三脑室造瘘术治疗。4例局限性脑积水患者接受了内镜下造瘘术。1例孤立性第四脑室患儿接受了内镜下导水管成形术。15例行内镜手术的患者中，4例需要再次手术。在10例行ETV治疗的患者中，只有患有脊髓脊膜膨出的新生儿因初次手术失败而需要行脑室腹腔分流术。在4例行内镜下造瘘术治疗的患者中，2例因脑室内出血（IVH）后出现局限性脑积水的患儿接受了第二次造瘘术。1例出血性脑积水后孤立性第四脑室患者在初次手术后8个月出现复发。他接受了第二次手术，在导水管内植入支架以维持脑脊液循环。对于2岁以下、伴有IVH且与脊髓脊膜膨出相关的脑积水患儿，可能需要足够大的造瘘口尺寸或植入支架，因为这些患儿继发梗阻的风险可能较高。
