Zuccaro Graciela, Ramos Javier Gonzalez
Department of Neurosurgery, Hospital Nacional de Pediatria Prof. Juan P. Garrahan, Cavia 3063, 1425 Buenos Aires, Argentina.
Childs Nerv Syst. 2011 Oct;27(10):1609-19. doi: 10.1007/s00381-011-1528-4. Epub 2011 Sep 17.
The study aims to assess the treatment of progressive multiloculated hydrocephalus. In a retrospective study, the authors reviewed their experience with different treatment modalities.
We have retrospectively evaluated 93 patients with progressive multiloculated hydrocephalus operated between 1988 and 2010. They represented around 2% (93/4,565) of all patients surgically treated for nontumoral hydrocephalus during this period of time at our institution.
Ventricular septal fenestration was carried out by craniotomy in 27 patients, endoscopic septum pellucidum fenestration in 19, endoscopic ventricular septal fenestration in 18, choroid plexectomy-fulguration in 14 (8 endoscopically and 6 by craniotomy), and third ventriculostomy in 2. Hydrocephalus was resolved in 21 patients with shunting, placing two ventricular catheters as the only procedure. Out of the 72 remaining patients, 34 underwent only one treatment, 30 two treatments, and 8 three or more procedures. The majority of patients ultimately required CSF shunt placement with only one ventricular catheter.
(1) Multiloculated hydrocephalus is a severe disease in which no single treatment has clearly been shown to be superior. (2) The goal of treatment is to restore communication between isolated intraventricular compartments in order to create the possibility of the implantation of a simple shunt with only one intraventricular catheter. More than improving the quality of life the patient, the objective is to reduce the number of surgical procedures. (3) Given the complexity of multiloculated hydrocephalus, each patient must be studied individually, and no procedure proposed by the literature should be ruled out, no matter how old fashioned may appear.
本研究旨在评估进展性多房性脑积水的治疗方法。在一项回顾性研究中，作者回顾了他们采用不同治疗方式的经验。
我们回顾性评估了1988年至2010年间接受手术治疗的93例进展性多房性脑积水患者。他们约占同期在我们机构接受非肿瘤性脑积水手术治疗的所有患者的2%（93/4565）。
27例患者通过开颅手术进行脑室间隔造瘘，19例进行内镜下透明隔造瘘，18例进行内镜下脑室间隔造瘘，14例（8例通过内镜，6例通过开颅手术）进行脉络丛切除-电灼术，2例进行第三脑室造瘘术。21例分流患者的脑积水得到解决，仅放置两根脑室导管作为唯一的手术操作。在其余72例患者中，34例仅接受了一次治疗，30例接受了两次治疗，8例接受了三次或更多次手术。大多数患者最终需要仅放置一根脑室导管的脑脊液分流术。
（1）多房性脑积水是一种严重疾病，尚无单一治疗方法被明确证明更具优势。（2）治疗的目标是恢复孤立脑室内腔之间的连通性，以便有可能植入仅带有一根脑室内导管的简单分流装置。目标不仅仅是改善患者的生活质量，还在于减少手术次数。（3）鉴于多房性脑积水的复杂性，必须对每位患者进行个体化研究，文献中提出的任何手术方法都不应被排除，无论其看起来多么过时。
