Baldauf Jörg, Oertel Joachim, Gaab Michael R, Schroeder Henry W S
Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
Neurosurgery. 2006 Sep;59(3):539-44; discussion 539-44. doi: 10.1227/01.NEU.0000228681.45125.E9.
The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases.
Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale.
In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4.
Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.
大面积小脑梗死所致梗阻性脑积水的外科治疗仍存在争议。为避免神经功能进行性恶化，更常用的手术方法是基于临时性脑室外引流或置入永久性分流系统。据我们所知，这是首例关于在小脑缺血性卒中所致梗阻性脑积水患者中使用内镜下第三脑室造瘘术（ETV）的报告。我们报告了10例回顾性病例的经验。
1997年至2004年间，10例因小脑占位性梗死导致脑积水的患者接受了ETV治疗。记录入院时的格拉斯哥昏迷量表评分、卒中病因以及计算机断层扫描征象，包括受累的缺血血管区域和脑水肿情况。使用格拉斯哥预后量表评估临床结局。
所有患者意识恶化至手术的平均间隔时间为4天。入院时格拉斯哥昏迷量表评分平均为11.2。9例患者中，ETV是脑室引流的初始手术。1例患者最初接受了脑室外引流治疗，但引流装置脱位后进行了ETV。1例患者在初次ETV术后7天因造瘘口功能障碍而需要进行脑室外引流。1例患者在ETV术后2天出现进行性脑水肿，随后进行了枕下减压术。8例成功治疗的患者在ETV术后意识水平有所改善。所有患者出院时格拉斯哥预后量表评分平均为3.4。
小脑梗死所致梗阻性脑积水并不常见。当观察到梗阻性脑积水时，ETV可成功应用且风险极小，尤其是可避免因外部引流系统导致的较高感染并发症发生率。
