Hu Zhi-Qiang, Zhu Guang-Tong, Huang Hui, Dai Bin, Guan Feng, Xiao Zhi-Yong, Zhang Yao
Department of Neurosurgery, Beijing Shijitan Hospital, Beijing 100038, China.
Zhonghua Yi Xue Za Zhi. 2010 Dec 21;90(47):3318-22.
To assess the pre-operative examination and operative approach for hydrocephalus associated with cerebellar tonsillar hernia.
A retrospective analysis was conducted for 24 patients of hydrocephalus associated with cerebellar tonsillar hernia. All subjects received both pre-operative and post-operative Cine MRI examinations to detect the velocity and quantity of cerebrospinal fluid (CSF) at the important sites in ventricular system. A majority of cases had endoscopic third ventriculostomy (ETV) while others underwent both ETV and endoscopic posterior cranial fossa decompression.
The pre-operative CSF hydrodynamics of all cases were abnormal at foramen magnum. A post-operative CSF flow through stoma might be detected by Cine MRI in all cases. The clinical symptoms improved to different extents in 21 cases while another two cases showed no improvement. Later these two patients underwent endoscopic posterior cranial fossa decompression. Cerebellar tonsillar hernia improved in 14 cases.
Cine MRI can detect the CSF hydrodynamics at craniocervical junction so as to help a surgeon determine the time and the plan of operation. Most cases of hydrocephalus associated with cerebral tonsillar hernia are of obstructive hydrocephalus. The efficacy of ETV for hydrocephalus has been confirmed. Also ETV has a therapeutic effect for cerebellar tonsillar hernia and syringomyelia.
评估小脑扁桃体疝合并脑积水的术前检查及手术方式。
对24例小脑扁桃体疝合并脑积水患者进行回顾性分析。所有患者术前行电影磁共振成像（Cine MRI）检查，术后再次行该检查，以检测脑室系统重要部位脑脊液（CSF）的流速和流量。多数病例行内镜下第三脑室造瘘术（ETV），其他病例则同时行ETV及内镜下后颅窝减压术。
所有病例术前枕大孔处脑脊液流体动力学均异常。所有病例术后电影磁共振成像均可检测到通过造瘘口的脑脊液流动。21例患者临床症状有不同程度改善，2例无改善。随后这2例患者接受了内镜下后颅窝减压术。14例患者小脑扁桃体疝有所改善。
电影磁共振成像可检测颅颈交界处脑脊液流体动力学，有助于外科医生确定手术时机及手术方案。多数小脑扁桃体疝合并脑积水病例为梗阻性脑积水。ETV治疗脑积水的疗效已得到证实。此外，ETV对小脑扁桃体疝及脊髓空洞症也有治疗作用。
