Roth Jonathan, Ben-Sira Liat, Udayakumaran Suhas, Constantini Shlomi
Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
Childs Nerv Syst. 2012 Mar;28(3):453-9. doi: 10.1007/s00381-011-1639-y. Epub 2011 Nov 29.
Fourth ventricular outlet obstruction (FVOO) causes obstructive hydrocephalus. Often, despite high-quality MRI sequences, differentiation between FVOO and communicating (absorptive) hydrocephalus is not easy. We describe our initial experience with five children with suspected FVOO that underwent CT ventriculography (CTV) or cisternography (CTC), to assist with this difficult diagnosis.
Over 2.5 years, five children with suspected FVOO (5 months-7.5 years old) underwent CTV or CTC. Technical and clinical data were retrospectively collected.
Four children had progressive macrocephaly, and one child had progressive ventriculomegaly. On CTV/CTC, four of five children showed communication between the ventricular system and spinal subarachnoid space or prepontine cistern, as evidenced by passage of contrast material. One child had a FVOO and therefore underwent an endoscopic third ventriculostomy, and is since, symptom and shunt free for 2.5 years.
CT ventriculography in infants, and CT cisternography in elder children, may assist to differentiate between FVOO and communicating hydrocephalus. The importance of these tests is for children with MRI suggestive of FVOO related hydrocephalus, but with no clear demonstration of the obstruction site. The implication of this differentiation may be for deciding between treatment of hydrocephalus with a ventriculoperitoneal shunt or with an endoscopic third ventriculostomy.
第四脑室出口梗阻（FVOO）可导致梗阻性脑积水。通常，尽管有高质量的MRI序列，区分FVOO和交通性（吸收性）脑积水并不容易。我们描述了对5例疑似FVOO的儿童进行CT脑室造影（CTV）或脑池造影（CTC）的初步经验，以辅助这一困难的诊断。
在2.5年的时间里，5例疑似FVOO的儿童（5个月至7.5岁）接受了CTV或CTC检查。回顾性收集技术和临床数据。
4例儿童有进行性巨头畸形，1例儿童有进行性脑室扩大。在CTV/CTC上，5例儿童中有4例显示脑室系统与脊髓蛛网膜下腔或脑桥前池之间有交通，造影剂通过可证明这一点。1例儿童患有FVOO，因此接受了内镜下第三脑室造瘘术，此后2.5年无症状且无需分流。
婴儿的CT脑室造影和大龄儿童的CT脑池造影可能有助于区分FVOO和交通性脑积水。这些检查的重要性在于针对MRI提示FVOO相关脑积水但梗阻部位未明确显示的儿童。这种区分的意义可能在于决定采用脑室腹腔分流术还是内镜下第三脑室造瘘术治疗脑积水。
