Mobbs Ralph J, Vonau Marianne, Davies Mark A
The Prince of Wales Hospital, Sydney, New South Wales, Australia.
Neurosurgery. 2003 Aug;53(2):384-5; discussion 385-6. doi: 10.1227/01.neu.0000073534.04767.b1.
Late failure after successful third ventriculostomy is rare, and death caused by failure of a previously successful third ventriculostomy has been reported on four occasions. We describe a simple innovation that adds little morbidity and has the potential to reduce the advent of death after late failure of endoscopic third ventriculostomy.
After endoscopic fenestration of the floor of the third ventricle, a ventricular catheter and subcutaneous reservoir are placed via the endoscope path. With acute blockage and neurological deterioration, cerebrospinal fluid can be removed via needle puncture of the reservoir until consultation with a neurosurgeon.
From 1979 to 2003, more than 240 endoscopic third ventriculostomies have been performed at our institution, with one death after late failure. The revised technique was devised after this death and has been performed on 21 patients to date.
The addition of a reservoir adds little time and morbidity to the procedure and offers the potential to sample cerebrospinal fluid, measure intracranial pressure, and reduce mortality associated with late failure of endoscopic third ventriculostomy.
成功的第三脑室造瘘术后晚期失败罕见，既往有4例报道称因先前成功的第三脑室造瘘失败导致死亡。我们描述了一种简单的创新方法，其几乎不增加发病率，并且有可能降低内镜下第三脑室造瘘术后晚期失败导致的死亡发生率。
在内镜下打开第三脑室底部后，通过内镜路径置入脑室导管和皮下贮液器。出现急性梗阻和神经功能恶化时，在与神经外科医生会诊前，可通过穿刺贮液器抽取脑脊液。
1979年至2003年，我们机构共进行了240余例内镜下第三脑室造瘘术，有1例在晚期失败后死亡。该改良技术是在这例死亡后设计的，迄今为止已应用于21例患者。
增加一个贮液器在手术中几乎不增加时间和发病率，并且有可能对脑脊液进行采样、测量颅内压以及降低内镜下第三脑室造瘘术后晚期失败相关的死亡率。
