Gangemi Michelangelo, Maiuri Francesco, Naddeo Michele, Godano Umberto, Mascari Carmelo, Broggi Giovanni, Ferroli Paolo
Department of Neurological Sciences, Section of Neurosurgery, Federico II University School of Medicine, Naples, Italy.
Neurosurgery. 2008 Jul;63(1):62-7; discussion 67-9. doi: 10.1227/01.NEU.0000335071.37943.40.
The aim of the report is to define the indications and results of endoscopic third ventriculostomy (ETV) in idiopathic normal pressure hydrocephalus and to discuss the physiopathological mechanism of this procedure.
The cases of 110 patients with idiopathic normal pressure hydrocephalus who underwent ETV in four Italian neurosurgical centers were retrospectively reviewed. The postoperative outcome was correlated with patient age, length of clinical history, preoperative clinical score, symptoms of clinical onset, type of hydrocephalus, and intraoperative findings.
The follow-up period ranged from 2 to 12 years (average, 6.5 yr). The outcome evaluation was made 2 years after the procedure. Postoperative clinical improvement occurred in 76 (69.1%) of 110 patients. There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle). Conversely, the rate of neurological improvement was higher in patients with shorter clinical history, better preoperative neurological score, and clinical onset with gait disturbances. Moreover, the intraoperative finding of the sudden reappearance of normal cerebral pulsations and significant downward and upward movements of the third ventricular floor after ETV was also correlated with a good outcome.
ETV results in a relatively high rate of clinical improvement and a low complication rate in patients with idiopathic normal pressure hydrocephalus. Therefore, it may be easily performed with the same approach used for intracranial pressure monitoring with low morbidity. However, our data must be confirmed by additional studies.
本报告旨在明确内镜下第三脑室造瘘术（ETV）治疗特发性正常压力脑积水的适应症及效果，并探讨该手术的病理生理机制。
回顾性分析意大利四个神经外科中心110例接受ETV治疗的特发性正常压力脑积水患者的病例。术后结果与患者年龄、临床病史长度、术前临床评分、临床发病症状、脑积水类型及术中发现相关。
随访时间为2至12年（平均6.5年）。术后2年进行结果评估。110例患者中有76例（69.1%）术后临床症状改善。成功率与患者年龄或脑室扩大类型（正常或第四脑室扩大）无关。相反，临床病史较短、术前神经评分较好且临床发病表现为步态障碍的患者神经功能改善率较高。此外，术中发现ETV后正常脑搏动突然再现以及第三脑室底部明显上下移动也与良好预后相关。
ETV治疗特发性正常压力脑积水患者的临床改善率相对较高，并发症发生率较低。因此，使用与颅内压监测相同的方法即可轻松实施该手术，且发病率较低。然而，我们的数据必须通过更多研究加以证实。
