Jones R F, Stening W A, Brydon M
Department of Neurosurgery, Prince of Wales Children's Hospital, Sydney, Australia.
Neurosurgery. 1990 Jan;26(1):86-91; discussion 91-2. doi: 10.1097/00006123-199001000-00012.
Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure.
脑积水的长期颅外分流术存在诸多与分流器故障和感染相关的缺点。在某些情况下，治疗结果非常令人失望。我们通过使用颅内脑脊液分流术，即第三脑室造瘘术，成功治疗了5例获得性导水管狭窄患者，且无明显并发症。第三脑室造瘘术最初由丹迪提出，但在很大程度上被颅外手术所取代。然而，随着手术技术的改进，第三脑室造瘘术现在被认为是某些特定病例中的一种可行替代方案。在另外19例患者中，我们随后扩大了患者选择范围，包括患有阿诺德 - 奇亚里畸形、先天性非交通性脑积水和肿瘤的患者。这些儿童中有三分之二无需分流器，除1名儿童术后出现偏瘫外，无明显并发症。尽管在晚发型组中取得了最佳效果，但即使是早发型非交通性脑积水也得到了成功治疗。即使在第三脑室造瘘术失败且随后需要脑室腹腔分流术的患者中，我们预计他们对分流器的依赖程度仍会较低，因为他们现在的脑积水是交通性的，往往不会有如此快速的发病或极高的颅内压升高水平。
