Mirone Giuseppe, Russo Carmela, Spennato Pietro, Mazio Federica, Nastro Anna, Cinalli Giuseppe
Department of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Department of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy.
World Neurosurg. 2019 Apr;124:214-218. doi: 10.1016/j.wneu.2019.01.018. Epub 2019 Jan 21.
Interhypothalamic adhesions (IHAs) are horizontally oriented parenchymal bands of tissue connecting the medial hypothalamic regions across the third ventricle. They can be assessed with high-resolution magnetic resonance (MR) techniques.
We report MR and neuroendoscopic features of IHA in a 3-year-old boy without symptoms referable to the hypothalamus. He presented with obstructive hydrocephalus secondary to posterior fossa tumor. An endoscopic third ventriculostomy (ETV) was attempted but not performed because of the presence of a thick IHA, which prevented an approach to the floor of the third ventricle. During the procedure the patient also experienced supraventricular tachycardia. The procedure was aborted, and an external ventricular drainage was left in the ventricles until resolution of hydrocephalus after posterior fossa surgery. To the best of our knowledge, no study has previously described in detail endoscopic images of IHA.
MR imaging allows one to preoperatively identify most anatomic anomalies of the ventricular system and the floor of the third ventricle. However, an IHA that may prevent an approach to the floor of the third ventricle due to his thickness may be missed. This can be recognized only on direct vision, underlining the importance of endoscopy in neurosurgery.
下丘脑间粘连（IHAs）是横跨第三脑室连接下丘脑内侧区域的水平定向实质性组织带。可通过高分辨率磁共振（MR）技术对其进行评估。
我们报告了一名3岁无症状下丘脑相关症状男孩的IHA的MR和神经内镜特征。他因后颅窝肿瘤继发梗阻性脑积水。尝试进行内镜下第三脑室造瘘术（ETV），但由于存在厚厚的IHA而未实施，该IHA阻碍了进入第三脑室底部的操作。手术过程中患者还出现了室上性心动过速。手术中止，在脑室留置了外部脑室引流管，直至后颅窝手术后脑积水消退。据我们所知，此前尚无研究详细描述IHA的内镜图像。
MR成像能够在术前识别脑室系统和第三脑室底部的大多数解剖异常。然而，可能因厚度而阻碍进入第三脑室底部的IHA可能会被漏诊。这只有在直视下才能识别，强调了神经外科内镜检查的重要性。
