Brichtova Eva, Chlachula Martin, Hrbac Tomas, Lipina Radim
Clinic of Pediatric Surgery, Orthopaedics and Traumatology, Brno Faculty Hospital, Cernopolni 9, 62500 Brno, Czech Republic.
Minim Invasive Surg. 2013;2013:584567. doi: 10.1155/2013/584567. Epub 2013 Jul 28.
Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)-one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.
内镜下第三脑室造瘘术（ETV）是治疗梗阻性脑积水的常规且安全的手术。我们研究的目的是评估ETV治疗先前接受过脑室腹腔（V-P）分流植入术的小儿梗阻性脑积水患者的成功率。从2001年至2011年，对42例先前接受过V-P分流植入术的患者实施了ETV。所有患者均经MRI证实中脑导水管或第四脑室流出道存在梗阻。手术过程中，夹闭V-P分流管并实施ETV。若临床状态良好且MRI显示造瘘口功能正常，则在ETV术后3个月移除V-P分流管。这些有可能移除V-P分流管的患者被评估为手术成功。在我们的42例患者组中，29例（69%）手术成功。出现了2例严重并发症（4.7%）——1例患者在术后2.5年死亡，1例患者在术后1年因ETV延迟失败死亡。即使对于先前接受过V-P分流植入术的患者，ETV也是梗阻性脑积水的首选治疗方法。在急性或计划进行V-P分流手术翻修时，MRI是可行的，若诊断出脑室系统梗阻，脑积水可通过内镜解决。
