内镜下第三脑室造瘘术成功治疗特发性第四脑室出口梗阻：一例报告
Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report.
作者信息
Ishi Yukitomo, Asaoka Katsuyuki, Kobayashi Hiroyuki, Motegi Hiroaki, Sugiyama Taku, Yokoyama Yuka, Echizenya Sumire, Itamoto Koji
机构信息
Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan ; Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638 Japan.
Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan.
出版信息
Springerplus. 2015 Sep 30;4:565. doi: 10.1186/s40064-015-1368-x. eCollection 2015.
INTRODUCTION
Fourth ventricle outlet obstruction (FVOO) is a rare cause of obstructive hydrocephalus. We describe a case of idiopathic FVOO that was successfully treated with endoscopic third ventriculostomy (ETV).
CASE REPORT
A 3-year old boy without any remarkable medical history presented with a headache and vomiting. Computed tomography (CT) images, which had incidentally been taken 2 years previously due to a minor head injury, showed no abnormality. Magnetic resonance imaging on admission showed tetra-ventricular hydrocephalus associated with the dilatation of the fourth ventricle outlets, without any obstructive lesions. However, CT ventriculography, involving contrast medium injection through a ventricular catheter, suggested mechanical obstruction of the cerebrospinal fluid (CSF) at the fourth ventricle outlets. Thus, the patient was diagnosed with FVOO and ETV was performed; the hydrocephalus was subsequently resolved. Although hydrocephalus recurred 1 year postoperatively, re-ETV for the highly stenosed fenestration successfully resolved this condition.
CONCLUSIONS
ETV should be considered for FVOO treatment, particularly in idiopathic cases without CSF malabsorption.
引言
第四脑室出口梗阻（FVOO）是梗阻性脑积水的一种罕见病因。我们描述了一例经内镜第三脑室造瘘术（ETV）成功治疗的特发性FVOO病例。
病例报告
一名3岁男孩，无任何显著病史，出现头痛和呕吐症状。两年前因轻度头部受伤偶然进行的计算机断层扫描（CT）图像显示无异常。入院时的磁共振成像显示四脑室脑积水伴第四脑室出口扩张，无任何梗阻性病变。然而，通过脑室导管注入造影剂的CT脑室造影提示第四脑室出口处脑脊液（CSF）机械性梗阻。因此，该患者被诊断为FVOO并接受了ETV治疗；脑积水随后得到缓解。尽管术后1年脑积水复发，但对高度狭窄的造瘘口再次进行ETV成功解决了这一情况。
结论
对于FVOO的治疗应考虑ETV，尤其是在无CSF吸收不良的特发性病例中。
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