Lipina Radim, Palecek Tomas, Reguli Stefan, Kovarova Magdalena
Department of Neurosurgery, University Hospital Ostrava, 17. listopadu 1790, Ostrava-Poruba 708 52, Czech Republic.
Childs Nerv Syst. 2007 Jul;23(7):815-9. doi: 10.1007/s00381-007-0316-7. Epub 2007 Mar 27.
Late failure of originally successful endoscopic third ventriculostomy (ETV) is considerably less common than failure of ventriculo-peritoneal (V-P) shunt in treatment of hydrocephalus. Death in consequence of late ETV failure is a very rare complication, so far having been mentioned in literature in 13 patients only.
We present the case of an 11-year-old girl who died in consequence of ETV failure 26 months after the endoscopic procedure. Histopathology proved the closure of stoma by gliotic tissue.
We can assume that reduced compliance of the ventricular wall in long-term V-P shunt, aqueductal stenosis as a cause of hydrocephalus as well as rapid onset of clinical symptoms prior to ETV might be the cause of acute onset of intracranial hypertension after late ETV failure. Potential prevention of sudden death seems to be the implantation of subcutaneous reservoir during the endoscopic procedure, which allows simple and rapid reduction of intraventricular pressure.
在治疗脑积水方面，原本成功的内镜下第三脑室造瘘术（ETV）晚期失败的情况比脑室-腹腔（V-P）分流术失败少见得多。ETV晚期失败导致死亡是一种非常罕见的并发症，迄今为止文献中仅提及13例患者。
我们报告一例11岁女孩，在内镜手术后26个月因ETV失败死亡。组织病理学证实造口被胶质组织封闭。
我们可以推测，长期V-P分流导致脑室壁顺应性降低、导水管狭窄作为脑积水的病因以及ETV术前临床症状迅速出现可能是ETV晚期失败后颅内压急性升高的原因。在内镜手术期间植入皮下储液器似乎是预防猝死的一种方法，它可以简单快速地降低脑室内压力。
