Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
World Neurosurg. 2020 Aug;140:e240-e246. doi: 10.1016/j.wneu.2020.05.040. Epub 2020 May 11.
Endoscopic third ventriculostomy (ETV) is a widely accepted treatment for obstructive hydrocephalus. For most practitioners, this procedure will be performed without navigation guidance. Without such guidance, the complications associated with the procedure have ranged from 1% to 8%. We hypothesized that the discrepancy between the surface bony anatomy and internal cranial anatomy contributes to the morbidities associated with ETV. We tested this hypothesis by comparing the position of the entry point defined by the classic Kocher's point relative to the ideal entry point that would result in no manipulation of the endoscope defined by frame-based stereotaxis.
The cranial computed tomography scan of 58 patients who had undergone frame-based stereotactic ETV was reformatted into 3-dimensional renderings. The location of this entry point was compared with the Kocher point, as determined by the external bony anatomy.
Overall, >70% of the burr holes that provided an ideal trajectory to the third ventricle were ≥0.5 cm from the Kocher point in both the sagittal and the coronal planes. Median deviations of 0.74 and 0.81 cm in the coronal (P < 0.01) and sagittal (P < 0.0001) planes were observed.
The use of stereotactic endoscopic techniques increase the safety of third ventriculostomy by adding precision and reducing otherwise unnecessary surgical maneuvering.
内镜第三脑室造瘘术（ETV）是一种广泛接受的治疗梗阻性脑积水的方法。对于大多数医生来说，这项手术将在没有导航引导的情况下进行。没有这种引导，该手术相关的并发症范围从 1%到 8%不等。我们假设，表面骨解剖结构与内部颅解剖结构之间的差异导致了与 ETV 相关的并发症。我们通过比较经典 Kocher 点定义的入路点与通过基于框架的立体定向术定义的无内镜操作的理想入路点之间的位置关系，来验证这一假说。
对 58 例行基于框架的立体定向 ETV 的患者的头颅 CT 扫描进行了 3 维重建。将这个入路点的位置与外部骨性解剖结构确定的 Kocher 点进行比较。
总体而言，在矢状面和冠状面，超过 70%的提供理想第三脑室轨迹的颅骨钻孔与 Kocher 点的距离≥0.5 厘米。在冠状面（P<0.01）和矢状面（P<0.0001）上观察到的中位数偏差分别为 0.74cm 和 0.81cm。
立体定向内镜技术通过增加精确度和减少不必要的手术操作，提高了第三脑室造瘘术的安全性。
