Stachura Krzysztof, Moskała Marek
Klinika Neurochirurgii i Neurotraumatologii UJ CM, ul. Botaniczna, Kraków, Poland.
Neurol Neurochir Pol. 2010 Jan-Feb;44(1):87-90. doi: 10.1016/s0028-3843(14)60409-6.
Third ventriculostomy (TV) is the most common neuroendoscopic procedure for restoration of near physiological circulation of cerebrospinal fluid in obstructive hydrocephalus. Among 70 adults operated on using this technique, the authors encountered one case of spontaneous TV. Only a few case reports of spontaneous ventriculostomy revealed by ventriculography, flow-sensitive phase-contrast cine magnetic resonance imaging (MRI) or at autopsy have been published. A 43-year-old woman with symptoms of hydrocephalus and signs of chronic obstructive hydrocephalus secondary to aqueductal stenosis on MRI was qualified for TV. Enlarged infundibulo-mammillary triangle with perforation was noted intraoperatively. During the postoperative course, the condition of the patient partially improved although radiological appearance remained unchanged. Three weeks later symptoms of hydrocephalus recurred and the patient underwent an infusion test which revealed increased cerebrospinal fluid outflow resistance. Implantation of a ventriculo-peritoneal shunt yielded stable improvement. Spontaneous TV should be taken into consideration during selection of patients for TV, especially in cases with chronic obstructive hydrocephalus.
第三脑室造瘘术（TV）是梗阻性脑积水患者恢复脑脊液近生理循环最常用的神经内镜手术。在采用该技术进行手术的70例成人患者中，作者遇到1例自发性第三脑室造瘘。仅有少数经脑室造影、流动敏感相位对比电影磁共振成像（MRI）或尸检发现的自发性脑室造瘘病例报告发表。一名43岁女性，有脑积水症状，MRI显示因导水管狭窄继发慢性梗阻性脑积水体征，符合第三脑室造瘘术指征。术中发现漏斗乳头三角扩大并有穿孔。术后病程中，患者病情部分改善，尽管影像学表现未变。三周后脑积水症状复发，患者接受灌注试验，结果显示脑脊液流出阻力增加。植入脑室腹腔分流管后病情稳定改善。在为患者选择第三脑室造瘘术时，应考虑自发性第三脑室造瘘，尤其是慢性梗阻性脑积水患者。
