Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.
World Neurosurg. 2013 Feb;79(2 Suppl):S21.e1-7. doi: 10.1016/j.wneu.2012.02.015. Epub 2012 Feb 10.
The management of complex hydrocephalus is challenging. There is no consensus of the best treatment for isolated fourth ventricles, arachnoid cysts, and multiloculated hydrocephalus, although the avoidance of multiple shunts is desirable. We reviewed our experience with the use of endoscopic techniques to simplify complex multicompartmental hydrocephalus to determine its efficacy and safety.
We performed a retrospective study of 114 consecutive adults and children undergoing endoscopic management of hydrocephalus by a single surgeon. The type of hydrocephalus and endoscopic procedure performed were recorded. The management algorithm for simplification of complex hydrocephalus is reviewed. All patients were followed up in the office or by telephone.
A total of 143 endoscopic procedures were performed on 114 patients with a mean age of 4.4 years (4 weeks to 32 years). The endoscopic procedures performed included cyst fenestration, septum pellucidotomy, endoscopic third ventriculostomy, aqueductal plasty with and without stent, and removal of cystercicotic cysts. Twenty-two (19.3%) patients had planned staged endoscopic procedures. Mean follow up was 65 months (range 33-122 months). Eighty-two (72%) patients were reduced to 1 shunt, shunt independence was achieved in 32 (28%) patients, and only 8 (11%) patients required shunt revision in the follow-up period.
Endoscopic simplification of complex hydrocephalus enables dependence on only a single shunt in the majority of patients, and a significant proportion achieve shunt independence. Endoscopic management should be considered before the placement of a second shunt, and some cases require staged endoscopic procedures to adequately communicate multicompartmental hydrocephalus.
复杂脑积水的治疗具有挑战性。对于孤立性第四脑室、蛛网膜囊肿和多房性脑积水，尽管避免使用多个分流管是理想的，但尚无最佳治疗方法的共识。我们回顾了使用内镜技术简化复杂多腔室脑积水的经验，以确定其疗效和安全性。
我们对 114 例连续接受单一外科医生内镜治疗脑积水的成人和儿童进行了回顾性研究。记录脑积水的类型和内镜手术的类型。审查了简化复杂脑积水的管理算法。所有患者均在办公室或通过电话进行随访。
共对 114 例患者进行了 143 次内镜手术，平均年龄为 4.4 岁（4 周至 32 岁）。内镜手术包括囊肿开窗术、透明隔切开术、内镜第三脑室造瘘术、导水管成形术伴或不伴支架、囊虫性囊肿切除术。22 例（19.3%）患者计划进行分期内镜手术。平均随访时间为 65 个月（33-122 个月）。82 例（72%）患者减少到 1 个分流管，32 例（28%）患者实现了分流管独立性，在随访期间仅 8 例（11%）患者需要分流管修订。
内镜简化复杂脑积水使大多数患者仅依赖于单个分流管，很大一部分患者实现了分流管独立性。在放置第二个分流管之前，应考虑内镜治疗，一些病例需要分期内镜手术以充分沟通多腔室脑积水。
