Miki T, Nakajima N, Wada J, Haraoka J
Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
Minim Invasive Neurosurg. 2005 Jun;48(3):136-41. doi: 10.1055/s-2004-830265.
Neuroendoscopic aqueductoplasty (EAP) is a curative and radical procedure for obstructive hydrocephalus due to aqueductal stenosis that re-establishes the physiological circulation of cerebrospinal fluid (CSF). We assessed the indications for safe neuroendoscopic aqueductoplasty without stenting to treat aqueductal stenosis.
In the past 5 years, 6 (5.5 %) of the 110 patients with obstructive hydrocephalus due to aqueductal stenosis were judged to be suitable for EAP on the basis of the MRI features of the aqueduct and intraoperative neuroendoscopic findings from the third ventricle for the aqueductal stenosis. The remaining 104 patients were treated by neuroendoscopic third ventriculostomy. Indications for safe EAP were determined retrospectively based on the clinical features, preoperative MRI, intraoperative neuroendoscopic findings and outcome of the 6 patients who underwent EAP.
There were no deaths due to EAP. All of the patients showed improvement or resolution of their preoperative symptoms. In 5 patients, dilatation of the third ventricle and lateral ventricles diminished, and prestenotic dilatation of the aqueduct also disappeared. After an average follow-up period of 39.5 months, recurrence of aqueductal stenosis has not been observed. In one patient, there was a complication of oculomotor nerve paresis after EAP.
EAP can be considered the best surgical procedure for restoring physiological circulation of CSF in patients with obstructive hydrocephalus caused by aqueductal stenosis. However, EAP candidates must be selected very carefully using the following indications: 1) obstructive triventricular hydrocephalus with increased intracranial pressure, 2) translucent membranous stenosis or aqueduct obstruction, and 3) prestenotic dilatation of the aqueduct.
神经内镜下导水管成形术（EAP）是治疗导水管狭窄所致梗阻性脑积水的一种根治性手术，可重建脑脊液（CSF）的生理循环。我们评估了无支架置入的安全神经内镜下导水管成形术治疗导水管狭窄的适应证。
在过去5年中，110例导水管狭窄所致梗阻性脑积水患者中，有6例（5.5%）根据导水管的MRI特征及术中经第三脑室对导水管狭窄的神经内镜检查结果，被判定适合行EAP。其余104例患者接受了神经内镜下第三脑室造瘘术。基于6例行EAP患者的临床特征、术前MRI、术中神经内镜检查结果及预后，回顾性确定安全EAP的适应证。
无EAP相关死亡病例。所有患者术前症状均有改善或缓解。5例患者第三脑室和侧脑室扩张减轻，导水管狭窄前扩张也消失。平均随访39.5个月后，未观察到导水管狭窄复发。1例患者EAP术后出现动眼神经麻痹并发症。
EAP可被认为是恢复导水管狭窄所致梗阻性脑积水患者脑脊液生理循环的最佳手术方法。然而，必须使用以下适应证非常谨慎地选择EAP候选患者：1）伴有颅内压升高的梗阻性三脑室脑积水；2）半透明膜性狭窄或导水管梗阻；3）导水管狭窄前扩张。
