Torrez-Corzo J, Rodriguez-Della Vecchia R, Chalita-Williams J C, Rangel-Castilla L
Neuroendoscopic Clinic, Department of Neurosurgery, Instituto Potosino de Neurociencias, San Luis Potosi, Mexico.
Childs Nerv Syst. 2009 May;25(5):627-30. doi: 10.1007/s00381-009-0852-4. Epub 2009 Mar 19.
We report a patient who suffered from brainstem injury following ventriculoperitoneal (VP) shunt placement in the fourth ventricle.
A 20-year-old man with complex hydrocephalus and trapped fourth ventricle underwent a suboccipital placement of a VP shunt. Postprocedure patient developed double vision. Magnetic resonance imaging showed that the catheter was penetrating the dorsal brainstem at the level of the pontomedullary junction. Patient was referred to our Neuroendoscopic Clinic. Physical exam demonstrated pure right VI cranial nerve palsy. Patient underwent flexible endoscopic exploration of the ventricular system. Some of the endoscopic findings were severe aqueductal stenosis and brainstem injury from the catheter. Aqueductoplasty, transaqueductal approach into the fourth ventricle, and endoscopic repositioning of the catheter were some of the procedures performed. Patient recovered full neurological function. The combination of endoscopic exploration and shunt is a good alternative for patients with complex hydrocephalus. A transaqueductal approach to the fourth ventricle with flexible scope is an alternative for fourth ventricle pathology.
我们报告一例在第四脑室进行脑室腹腔（VP）分流术后发生脑干损伤的患者。
一名患有复杂性脑积水和第四脑室受压的20岁男性接受了枕下VP分流术。术后患者出现复视。磁共振成像显示导管在脑桥延髓交界处水平穿透背侧脑干。患者被转诊至我们的神经内镜诊所。体格检查显示单纯性右侧第六颅神经麻痹。患者接受了脑室系统的软性内镜探查。一些内镜检查结果为严重的导水管狭窄和导管所致的脑干损伤。进行了导水管成形术、经导水管进入第四脑室以及内镜下导管重新定位等一些操作。患者恢复了完全的神经功能。内镜探查和分流术相结合对于复杂性脑积水患者是一种很好的选择。采用软性内镜经导水管进入第四脑室是处理第四脑室病变的一种替代方法。
