Torres-Corzo Jaime, Sánchez-Rodríguez Juan, Cervantes Dominic, Rodríguez-Della Vecchia Roberto, Muruato-Araiza Fernando, Hwang Steven W, Rangel-Castilla Leonardo
*Department of Neurosurgery, Hospital Central, University of San Luis Potosi and School of Medicine, San Luis Potosi, Mexico; ‡Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts; §Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Neurosurgery. 2014 Apr;74(4):426-35; discussion 436. doi: 10.1227/NEU.0000000000000283.
Routinely, hydrocephalus related to fourth ventricular outlet obstruction (FVOO) has been managed with ventriculoperitoneal (VP) shunting or endoscopic third ventriculostomy (ETV). Few reports on Magendie foraminoplasty exist, and Luschka foraminoplasty has not been described.
To present an alternative technique in the management of FVOO via an endoscopic transventricular transaqueductal Magendie and Luschka foraminoplasty and to discuss the indications, technique, findings, and outcomes.
Between 1994 and 2011, all patients who underwent endoscopic Magendie and Luschka foraminoplasty were analyzed.
A total of 33 Magendie (28) and/or Luschka (5) foraminoplasties were performed in 30 patients. Twenty-three were adult and 7 were pediatric patients. The etiology of the FVOO was divided into primary etiologies (congenital membrane in 5 and atresia in 2) and secondary causes (neurocysticercosis in 14 patients, bacterial meningitis in 9). Fifteen (50%) had previously failed procedures. Intraoperative findings that led to Magendie/Luschka foraminoplasty were ETV not feasible to perform, nonpatent basal subarachnoid space, or primary FVOO. Minor postoperative complications were seen in 3 patients. Only 26 patients had long-term follow-up; 17 (65.3%) of these had clinical improvement and did not require further procedures. Nine (34.7%) did not improve. Eight required another procedure (7 shunts, and 1 endoscopic procedure). One patient died.
Flexible neuroendoscopic transventricular transforaminal Magendie and Luschka foraminoplasty is feasible and safe. These procedures may prove to be viable alternatives to standard ETV and VP shunt in appropriate patients. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.
通常，与第四脑室出口梗阻（FVOO）相关的脑积水采用脑室腹腔分流术（VP）或内镜下第三脑室造瘘术（ETV）进行治疗。关于马根迪孔成形术的报道很少，而路施卡孔成形术尚未见描述。
介绍一种通过内镜经脑室经导水管马根迪孔和路施卡孔成形术治疗FVOO的替代技术，并讨论其适应证、技术、发现和结果。
分析1994年至2011年间所有接受内镜下马根迪孔和路施卡孔成形术的患者。
30例患者共进行了33次马根迪孔（28次）和/或路施卡孔（5次）成形术。23例为成人患者，7例为儿童患者。FVOO的病因分为原发性病因（先天性隔膜5例，闭锁2例）和继发性病因（神经囊尾蚴病14例，细菌性脑膜炎9例）。15例（50%）患者先前手术失败。导致进行马根迪孔/路施卡孔成形术的术中发现为ETV无法实施、基底蛛网膜下腔不通畅或原发性FVOO。3例患者出现轻微术后并发症。仅26例患者进行了长期随访；其中17例（65.3%）临床症状改善，无需进一步手术。9例（34.7%）未改善。8例需要再次手术（7例分流术，1例内镜手术）。1例患者死亡。
灵活的神经内镜经脑室经孔马根迪孔和路施卡孔成形术是可行且安全的。在合适的患者中，这些手术可能被证明是标准ETV和VP分流术的可行替代方案。对ETV成功进行充分的术中评估对于确定受益患者至关重要。
