da Silva Luciano Ricardo França, Cavalheiro Sérgio, Zymberg Samuel Tau
Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
Childs Nerv Syst. 2007 Nov;23(11):1263-8. doi: 10.1007/s00381-007-0393-7. Epub 2007 Aug 4.
Endoscopic aqueductoplasty is an option of treatment of obstructive hydrocephalus caused by aqueductal stenosis. We report on our experience with this endoscopic technique.
Eighteen patients with primary or secondary aqueductal stenosis underwent endoscopic aqueductoplasty (EA) with or without stenting between July 2004 and January 2007. EA, EA with a stent, EA with endoscopic third ventriculostomy (ETV), and EA with stenting in addition to ETV were performed in eight, five, three, and two patients, respectively. A repeat endoscopic procedure was done in one patient. EA with a stent was performed in case 1, 8 months after first endoscopic procedure. In four cases, aqueductoplasty with stent was performed through a suboccipital approach.
There were no deaths due to the neuroendoscopic procedures. All of the patients showed improvement or resolution of their preoperative symptoms, although in case 1 a new endoscopic procedure was performed: EA with a stent.
Cerebral aqueductoplasty is an effective and successful treatment for membranous and/or short-segment stenosis of the sylvian aqueduct. Endoscopic aqueductoplasty candidates must be selected very carefully but longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.
内镜下导水管成形术是治疗导水管狭窄所致梗阻性脑积水的一种治疗选择。我们报告我们在这种内镜技术方面的经验。
2004年7月至2007年1月期间，18例原发性或继发性导水管狭窄患者接受了内镜下导水管成形术（EA），部分患者同时或未同时置入支架。单纯EA、EA联合支架置入、EA联合内镜下第三脑室造瘘术（ETV）以及EA联合支架置入及ETV分别应用于8例、5例、3例和2例患者。1例患者进行了再次内镜手术。病例1在首次内镜手术后8个月进行了EA联合支架置入术。4例患者通过枕下入路进行了带支架的导水管成形术。
神经内镜手术无死亡病例。所有患者术前症状均有改善或缓解，尽管病例1进行了再次内镜手术：EA联合支架置入术。
大脑导水管成形术是治疗大脑导水管膜性和/或短节段狭窄的一种有效且成功的治疗方法。必须非常谨慎地选择内镜下导水管成形术的候选患者，但需要更长的随访时间来评估导水管成形术后导水管的长期通畅情况。
