Cai Qiang, Zhang Xiangyang, Wang Long, Huang Shulan, Chen Zhibiao, Chen Qianxue
Department of Neurosurgery, Renmin Hospital of Wuhan University, Hubei Province, China.
Medicine (Baltimore). 2017 Jan;96(1):e5823. doi: 10.1097/MD.0000000000005823.
The aim of the study was to explore keyhole approach and dura suture in the neuroendoscopic treatment for hydrocephalus.Twelve cases of hydrocephalus patients who were treated with neuroendoscope by this approach were analyzed retrospectively from April 2015 to April 2016 in our department. The basic steps of this procedure was using drill and milling cutter to form a small bone flap instead of burr hole, and then making a cruciate incision on the dura. After endoscopic third ventriculostomy or endoscopic third ventriculostomy + ventriculocystostomy finished, dura was sutured and the bone flap was reset.All 12 patients could suture dura effectively, and no cerebrospinal fluid leak and subcutaneous cerebrospinal fluid collection happened; symptoms of hydrocephalus were also improved. Moreover, during the operation, we found this approach could suspend dura, and avoid the cerebral sulcus and cortical coarse vein effectively, which could reduce the risk of intracranial hemorrhage. In addition, we found this approach could increase the reachable range of the neuroendoscope significantly.Keyhole approach can suture dura and avoid the cerebral sulcus and cortical coarse vein effectively, increase the indications, and reduce complications of neuroendoscope. So, this approach has clinical values and can be used in hydrocephalus.
本研究旨在探讨锁孔入路及硬脑膜缝合在神经内镜治疗脑积水中的应用。回顾性分析2015年4月至2016年4月在我科采用该入路行神经内镜治疗的12例脑积水患者。该手术的基本步骤是使用钻和铣刀形成小骨瓣而非骨孔，然后在硬脑膜上做十字形切口。在内镜下第三脑室造瘘术或内镜下第三脑室造瘘术+脑室囊肿造瘘术完成后，缝合硬脑膜并复位骨瓣。12例患者均能有效缝合硬脑膜，未发生脑脊液漏及皮下脑脊液积聚；脑积水症状也得到改善。此外，术中发现该入路可悬吊硬脑膜，有效避开脑沟和皮质粗大静脉，从而降低颅内出血风险。另外，发现该入路可显著增加神经内镜的可及范围。锁孔入路能有效缝合硬脑膜，避开脑沟和皮质粗大静脉，增加适应证，减少神经内镜并发症。因此，该入路具有临床应用价值，可用于脑积水治疗。
