Arjipour Mahdi, Hanaei Sara, Habibi Zohreh, Esmaeili Arash, Nejat Farideh, El Khashab Mostafa
Department of Neurosurgery, Shariati Hospital, Tehran, Iran.
Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Neurosci. 2015 Jan-Mar;10(1):1-4. doi: 10.4103/1817-1745.154309.
Endoscopic procedure has been known as the method of choice for treatment of hydrocephalus with 8.5% complication rate. It seems that good dural closure, reconstructing bone defect and perfect pericranium suturing can decrease the wound complications. Here, we describe the method of minicraniotomy instead of the burr hole in the endoscopic procedure.
A case-control study regarding the cranial opening for endoscopic surgery was done in 45 patients of <12 months age; 15 patients in case group for minicraniotomy and 30 infants as control group for burr hole. They were followed at least 1-month for complications including cerebrospinal fluid collection, wound dehiscence, wound infection, and meningitis.
Patients were between 1 and 11 months. Hydrocephalus (73%) was the most common etiology for endoscopic surgery in this series, followed by the arachnoid cyst (20%). Two patients in the case group and eight in control group developed complications. Meningitis was found in one infant in the control group. Despite less complications in the case group the difference between two cohorts was not statistically significant.
Minicraniotomy with providing more space in comparison to burr hole makes dural closure possible. It provides a small bone flap that can be replaced inside the bone defect. In spite of nonsignificant statistical difference between two groups regarding complication rate, we found less wound complications with minicraniotomy. Therefore, we advise this technique for the endoscopic procedure and propose minicraniotomy even in the older population to provide better dural opening, watertight dural closure and reconstructing the bone defect.
内镜手术已被公认为治疗脑积水的首选方法，并发症发生率为8.5%。良好的硬脑膜闭合、修复骨缺损和完美的帽状腱膜缝合似乎可以减少伤口并发症。在此，我们描述在内镜手术中使用小骨瓣开颅术替代钻孔术的方法。
对45例年龄小于12个月的患者进行了一项关于内镜手术颅骨开口的病例对照研究；15例患者作为小骨瓣开颅术病例组，30例婴儿作为钻孔术对照组。对他们进行了至少1个月的随访，观察并发症，包括脑脊液积聚、伤口裂开、伤口感染和脑膜炎。
患者年龄在1至11个月之间。脑积水（73%）是本系列内镜手术最常见的病因，其次是蛛网膜囊肿（20%）。病例组有2例患者发生并发症，对照组有8例。对照组有1例婴儿发生脑膜炎。尽管病例组并发症较少，但两组之间的差异无统计学意义。
与钻孔术相比，小骨瓣开颅术提供了更多空间，使硬脑膜闭合成为可能。它提供了一个小骨瓣，可以放回骨缺损处。尽管两组在并发症发生率上无显著统计学差异，但我们发现小骨瓣开颅术的伤口并发症较少。因此，我们建议在内镜手术中采用这种技术，甚至在年龄较大的人群中也建议采用小骨瓣开颅术，以实现更好的硬脑膜开口、防水性硬脑膜闭合和修复骨缺损。
