Sandoval-Balanzario Miguel Antonio, Rincón-Navarro Raúl Abraham, Granados-López Rommel, Santos-Franco Jorge Arturo
Servicio de Neurocirugía, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México.
Rev Med Inst Mex Seguro Soc. 2015 May-Jun;53(3):280-5.
Shunt devices to treat hydrocephalus are associated with a malfunction of 81 % at 12 years and 10 % of infection. The objective was to assess safeness and efficacy of endoscopic third ventriculostomy (ETV) for the treatment of chronic communicating hydrocephalus.
Eight patients with chronic communicating hydrocephalus were included in a period between September, 2012 and April, 2013. X ray computed tomography scans were performed when patients were admitted, after the surgery, and at 30, 180 and 365 days. The follow-up was of 251 days (the biggest was of 459 days). The variables included were: age, sex, etiology, time of evolution, and the total number of shunt malfunctions. Conventional technique with a 30° rigid endoscope was performed, malfunctional shunt was removed, and a tied shunt device was placed.
Four males and four females, with a mean age of 42 years (27-63 years); neurocysticercosis was identified in five patients (62.5 %); the evolution rate was of 18 years (15-30 years); the hospital stay rate was of 6.5 days (3-22 days); the mean of previous shunt malfunctions was 4 (1-6).
neuroinfection in one patient, malfunction in three patients. None of them died.
ETV is a safety procedure for treating chronic communicating hydrocephalus; it has a success rate higher than 60 %. Neurocysticercosis showed better results when previous shunt malfunctions were lower than three.
治疗脑积水的分流装置在12年时的故障率为81%，感染率为10%。目的是评估内镜下第三脑室造瘘术（ETV）治疗慢性交通性脑积水的安全性和有效性。
2012年9月至2013年4月期间纳入8例慢性交通性脑积水患者。患者入院时、手术后、30天、180天和365天时进行X线计算机断层扫描。随访251天（最长459天）。纳入的变量包括：年龄、性别、病因、病程及分流装置故障总数。采用30°硬式内镜常规技术，取出故障分流装置，放置结扎的分流装置。
4例男性，4例女性，平均年龄42岁（27 - 63岁）；5例患者（62.5%）确诊为神经囊尾蚴病；病程18年（15 - 30年）；住院时间6.5天（3 - 22天）；既往分流装置故障平均4次（1 - 6次）。
1例患者发生神经感染，3例患者出现分流装置故障。无一例死亡。
ETV是治疗慢性交通性脑积水的安全手术；成功率高于60%。既往分流装置故障少于3次时，神经囊尾蚴病的治疗效果更佳。
