Tabakow P, Czyz M, Jarmundowicz W, Zub W
Department of Neurosurgery, W roclaw Medical University, W roclaw, Poland.
Minim Invasive Neurosurg. 2011 Jun;54(3):138-41. doi: 10.1055/s-0031-1283169. Epub 2011 Aug 23.
Treatment of multiloculated hydrocephalus in children remains a difficult neurosurgical problem because of the high recurrence rate. Endoscopic septostomy with subsequent ventriculoperitoneal shunting is one of the most widely accepted therapeutic methods. Intraventricular endoscopic surgery combined with intraoperative magnetic resonance (MR) has been used very seldom in infants.
A 7-month-old infant presented with a history of postnatal hydrocephalus from the germinal matrix and intraventricular hemorrhage, treated with a ventriculoperitoneal shunt. Treatment was complicated by bacterial meningitis. On admission the child presented with symptoms of elevated intracranial pressure, an MR investigation gave evidence of multiloculated hydrocephalus. The patient underwent endoscopic pellucidotomy, followed by fenestration of the septa inside the third ventricle, third ventriculostomy and aqueductoplasty. Endoscopic navigation was supported by serial intraoperative non-contrast T1-weighted MR (0.15 T, Polestar N20, Medtronic) images. They also served for confirmation of the patency of performed fenestrations and for the planning of further steps of the operation.
Intraoperative low-field MR imaging provided an excellent tool for correct navigation of the endoscope inside the pathological ventricular compartments and for intraoperative assessment of surgical goals.
由于复发率高，小儿多房性脑积水的治疗仍然是一个棘手的神经外科问题。内镜下造瘘术并随后行脑室腹腔分流术是最广泛接受的治疗方法之一。脑室内内镜手术联合术中磁共振成像（MR）在婴儿中很少使用。
一名7个月大的婴儿因生发基质和脑室内出血导致出生后脑积水，接受了脑室腹腔分流术治疗。治疗过程中并发细菌性脑膜炎。入院时，患儿出现颅内压升高症状，磁共振检查显示多房性脑积水。该患者接受了内镜下透明隔造瘘术，随后对第三脑室内的隔膜进行开窗、第三脑室造瘘术和导水管成形术。术中通过连续的非增强T1加权磁共振成像（0.15T，北极星N20，美敦力公司）图像辅助内镜导航。这些图像还用于确认所做开窗的通畅性以及规划手术的进一步步骤。
术中低场磁共振成像为在内镜在病理性脑室腔室内的正确导航以及手术目标的术中评估提供了一个极好的工具。
