Teegala Ramesh
Department of Neurosurgery, Alluri Sita Ramaraju Academy of Medical Sciences Hospital, Eluru, West Godavari, Andhra Pradesh, India.
Asian J Neurosurg. 2016 Jul-Sep;11(3):268-72. doi: 10.4103/1793-5482.145369.
Persistent or progressive hydrocephalus is one of the complex problems of posterior fossa tumors associated with hydrocephalus. The author evaluated the effectiveness of single-stage tumor decompression associated with a stent technique (trans aqueductal third ventricle - Cervical subarachnoid stenting) as an adjuvant cerebro spinal fluid (CSF) diversion procedure in controlling the midline posterior fossa tumors with hydrocephalus.
Prospective clinical case series of 15 patients was evaluated from July 2006 to April 2012. Fifteen clinicoradiological diagnosed cases of midline posterior fossa tumors with hydrocephalus were included in this study. All the tumors were approached through the cerebello medullary (telo velo tonsilar) fissure technique. Following the excision of the posterior fossa tumor, a sizable stent was placed across the aqueduct from the third ventricle to the cervical subarachnoid space.
There were nine male and six female patients with an average age of 23 years. Complete tumor excision could be achieved in 12 patients and subtotal excision with clearance of aqueduct in remaining three patients. Hydrocephalus was controlled effectively in all the patients. There were no stent-related complications.
This study showed the reliability of single-stage tumor excision followed by placement of aqueductal stent. The success rate of this technique is comparable to those of conventional CSF diversion procedures. This is a simple, safe, and effective procedure for the management of persistent and or progressive hydrocephalus. This technique may be very useful in situations where the patient's follow-up is compromised and the patients who are from a poor economic background. Long-term results need further evaluation to assess the overall functioning of this stent technique.
持续性或进行性脑积水是后颅窝肿瘤合并脑积水的复杂问题之一。作者评估了单阶段肿瘤减压联合支架技术（经导水管第三脑室 - 颈段蛛网膜下腔支架置入术）作为辅助性脑脊液（CSF）分流手术在控制合并脑积水的中线后颅窝肿瘤方面的有效性。
对2006年7月至2012年4月期间的15例患者进行前瞻性临床病例系列研究。本研究纳入了15例经临床放射学诊断为中线后颅窝肿瘤合并脑积水的病例。所有肿瘤均通过小脑延髓（终板扁桃体）裂入路技术进行处理。在后颅窝肿瘤切除后，将一个合适大小的支架经导水管从第三脑室放置到颈段蛛网膜下腔。
有9例男性和6例女性患者，平均年龄23岁。12例患者实现了肿瘤全切，其余3例患者次全切除并打通了导水管。所有患者的脑积水均得到有效控制。未出现与支架相关的并发症。
本研究表明了单阶段肿瘤切除后放置导水管支架的可靠性。该技术的成功率与传统脑脊液分流手术相当。这是一种用于治疗持续性和/或进行性脑积水的简单、安全且有效的方法。该技术在患者随访受限以及经济背景较差的患者中可能非常有用。长期结果需要进一步评估以评估该支架技术的整体功能。
