Department of Neurosurgery, Hannover Nordstadt Hospital, Hannover, Germany.
J Neurosurg. 2009 Dec;111(6):1119-26. doi: 10.3171/2009.4.JNS081149.
Object Endoscopic third ventriculostomy (ETV) is well accepted for obstructive hydrocephalus of various etiologies. Nevertheless, it is seldom considered in intracranial hemorrhage even in cases involving obstruction of the CSF circulation. Methods Between May 1993 and April 2008, 34 endoscopic procedures were performed for hemorrhage-related obstructive hydrocephalus with an intraventricular component. All patients were prospectively followed up. Special attention was paid to presurgical clinical status, type of hemorrhage, type of surgery, postsurgical clinical status, postsurgical ventricular size, and necessity of ventriculoperitoneal shunt implantation. Results An ETV was performed for treatment of obstructive hydrocephalus due to intracranial hemorrhage in 34 patients (15 male, 19 female; mean age 60.8 years [range 3 months-83 years]). Hydrocephalus was caused by 17 cerebellar, 6 thalamic, 5 intraventricular, 3 basal ganglia, 2 subarachnoid, and 1 pontine hemorrhage. Thirty-three patients (97.1%) presented with impaired consciousness. Intraventricular blood was present in all cases. In 16 cases (47.1%), blood clots had to be evacuated to achieve access to the third ventricle floor. The mean operation time was 58.2 minutes (range 25-120 minutes). Three complications occurred (rate of 8.8%) with 2 being asymptomatic (5.9%) and 1 being transient (2.9%). There was no procedure-related permanent morbidity, and no procedure-related mortality. After surgery, there was clinical improvement in 17 cases (50.0%) and radiological evidence of improvement in 22 cases (64.7%). Two patients required postoperative ventriculoperitoneal shunting (5.9%). Seven patients died of hemorrhage while in the hospital (20.6%), and another 4 died during follow-up (11.8%). Fifteen patients (44.1%) showed a persistent clinical improvement at the final follow-up (mean 12.2 months after surgery). Conclusions Endoscopic third ventriculostomy represents a safe treatment option in intraventricular hemorrhage-related obstructive hydrocephalus yielding similar results as an external drainage but with less risk of infection and a very low subsequent shunt placement rate. In cases with a predominant obstructive component, ETV should be considered in hydrocephalus due to intracerebral hemorrhage. However, performing an ETV with a blurred field of vision and distorted ventricular anatomy is a challenge for any endoscopic neurosurgeon and should be reserved for experienced neuroendoscopists.
内镜第三脑室造瘘术（ETV）已被广泛接受用于治疗各种病因引起的梗阻性脑积水。然而，即使在涉及脑脊液循环阻塞的情况下，它也很少被考虑用于颅内出血。
1993 年 5 月至 2008 年 4 月，对 34 例伴有脑室成分的出血相关性梗阻性脑积水患者进行了 34 次内镜手术。所有患者均进行前瞻性随访。特别关注术前临床状况、出血类型、手术类型、术后临床状况、术后脑室大小以及是否需要脑室-腹腔分流植入。
34 例患者（15 例男性，19 例女性；平均年龄 60.8 岁[3 个月-83 岁]）因颅内出血而行 ETV 治疗梗阻性脑积水。脑积水由 17 例小脑、6 例丘脑、5 例脑室、3 例基底节、2 例蛛网膜下腔和 1 例脑桥出血引起。33 例（97.1%）患者表现为意识障碍。所有病例均存在脑室积血。在 16 例（47.1%）中，需要清除血凝块以获得进入第三脑室底部的通道。平均手术时间为 58.2 分钟（25-120 分钟）。发生 3 例并发症（8.8%），其中 2 例为无症状（5.9%），1 例为短暂性（2.9%）。无手术相关永久性并发症，无手术相关死亡率。术后 17 例（50.0%）患者临床状况改善，22 例（64.7%）患者影像学证据改善。2 例患者术后需行脑室-腹腔分流术（5.9%）。7 例患者在住院期间死于出血（20.6%），另有 4 例在随访期间死亡（11.8%）。15 例（44.1%）患者在最终随访时表现出持续的临床改善（术后平均 12.2 个月）。
内镜第三脑室造瘘术是治疗脑室出血相关性梗阻性脑积水的一种安全治疗选择，其结果与外部引流相似，但感染风险较低，随后的分流植入率也非常低。在以梗阻为主的情况下，对于因脑出血引起的脑积水，应考虑 ETV。然而，对于视野模糊和脑室解剖结构扭曲的病例，任何内镜神经外科医生都面临挑战，应保留给有经验的神经内镜医生。
