University at Buffalo Department of Neurosurgery, Millard Fillmore Gates Hospital, 3 Gates Circle, Buffalo, NY 14209, USA.
J Neurol Neurosurg Psychiatry. 2010 Apr;81(4):374-8. doi: 10.1136/jnnp.2009.177360. Epub 2009 Sep 2.
A serious catastrophic complication of endoscopic third ventriculostomy (ETV) is basilar artery (BA) damage. Although the BA has been discussed as the cause of haemorrhage and even pseudoaneurysm, variations of the posterior cerebral artery proximal segment (P1) and its protrusion into the third ventricle floor have not been emphasised. A series of cases are reported in which the P1 segment was located at the stoma during an ETV and was at risk of perforation. Precautionary techniques for complication avoidance are described.
A retrospective review was performed of all ETVs performed in adults at our institution between 2004 and 2008. Cases were identified in which the P1 segment was noted to herniate into the stoma at the time of third ventricular floor fenestration.
Among 65 cases reviewed, six were identified in which the P1 segment significantly herniated into an area of the stoma at the time of third ventricular floor fenestration. In no case was the P1 segment injured by the ETV procedure. Each of the six patients had opaque third ventricle floors. A 'cookie cut' technique was used in which the opaque third ventricle floor was abraded to reveal the underlying translucent membrane, offering an improved view of arteries in the basilar cisterns. In four of six patients, ETV resulted in clinical improvement.
The posterior cerebral artery P1 segment is potentially at risk during ETV in adults as well as in children. Awareness and proper precautions may help reduce injuries to either the P1 or the basilar apex during an ETV.
内镜第三脑室造瘘术（ETV）的一个严重灾难性并发症是基底动脉（BA）损伤。尽管 BA 已被认为是出血甚至假性动脉瘤的原因，但大脑后动脉近端（P1）的变异及其向第三脑室底部突出尚未得到强调。报告了一系列病例，其中 P1 段在 ETV 期间位于造瘘口处，有穿孔的风险。描述了避免并发症的预防技术。
对我们机构 2004 年至 2008 年间进行的所有成人 ETV 进行回顾性审查。确定了在第三脑室底部开窗时发现 P1 段明显疝入造瘘口的病例。
在审查的 65 例病例中，有 6 例 P1 段在第三脑室底部开窗时明显疝入造瘘口区域。在任何情况下，P1 段均未因 ETV 手术而受伤。这 6 名患者的第三脑室底部均不透光。采用“饼干切割”技术，磨除不透光的第三脑室底部，以显露下方的半透明膜，从而提供基底池内动脉的更好视图。在 6 例患者中的 4 例中，ETV 导致临床改善。
成人和儿童的 ETV 过程中，大脑后动脉 P1 段存在潜在风险。在 ETV 过程中，提高认识并采取适当的预防措施，可能有助于减少 P1 段或基底尖部的损伤。
