Roth Jonathan, Constantini Shlomi
Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
Childs Nerv Syst. 2012 Aug;28(8):1163-9. doi: 10.1007/s00381-012-1838-1. Epub 2012 Jun 24.
In a previous well-controlled study, routine endoscopic-guided placement of ventricular catheters did not seem to decrease the rate of shunt failure or proximal shunt malfunction. Since this study was published, this technique does not seem to gain much acceptance. However, in selected cases, it may assist in accuracy and safety. We therefore have analyzed our experience with selective intra-catheter endoscopic use for ventricular hardware placement.
We retrospectively collected clinical and radiological data on all children undergoing intra-catheter endoscopic-assisted ventricular catheter placement.
During 25 months, 16 children (ages 3 months-18 years) underwent 18 procedures using the above technique. Indications for surgery were: proximal shunt malfunction with relatively small ventricles (ten children), proximal shunt malfunction with intraventricular membranes (one child), proximal shunt malfunction with distorted ventricles (one child), new shunt with small to medium sized ventricles (two children), or large ventricles and a loculated fourth ventricle secondary to an aqueductal web (two children). Fourteen procedures were technically successful. The catheter was properly located on postoperative imaging in 13 procedures. Frameless navigation was used in three cases.
Selective use of intra-catheter endoscopic-assisted proximal shunt placement is useful and may be indicated in small or distorted ventricles and in cases when fenestration of an intraventricular membrane or aqueductal web is indicated. The main value of such a technique is the ability to accurately place the catheter tip within distorted or small ventricles. Larger series are needed to refine these indications.
在之前一项严格对照的研究中，常规内镜引导下放置脑室导管似乎并未降低分流失败或近端分流故障的发生率。自该研究发表以来，这项技术似乎并未得到广泛认可。然而，在某些特定情况下，它可能有助于提高准确性和安全性。因此，我们分析了我们在选择性导管内内镜用于脑室硬件放置方面的经验。
我们回顾性收集了所有接受导管内内镜辅助脑室导管放置的儿童的临床和放射学数据。
在25个月期间，16名儿童（年龄3个月至18岁）使用上述技术进行了18次手术。手术指征为：脑室相对较小的近端分流故障（10名儿童）、脑室内有隔膜的近端分流故障（1名儿童）、脑室变形的近端分流故障（1名儿童）、中小脑室的新分流（2名儿童），或因导水管膜导致的大脑室和第四脑室分隔（2名儿童）。14次手术在技术上成功。13次手术术后影像学显示导管位置正确。3例使用了无框架导航。
选择性使用导管内内镜辅助近端分流放置是有用的，在脑室小或变形以及需要对脑室内隔膜或导水管膜进行开窗的情况下可能适用。这种技术的主要价值在于能够将导管尖端准确放置在变形或小的脑室内。需要更大规模的系列研究来完善这些指征。
