Department of Neurosurgery, Graduate School of Medicine, Nagoya University.
Department of Neurosurgery, Ichinomiya Municipal Hospital.
Neurol Med Chir (Tokyo). 2020 Jul 15;60(7):351-359. doi: 10.2176/nmc.oa.2019-0299. Epub 2020 Jun 12.
An isolated fourth ventricle (IFV) is characterized by fourth ventricular dilation due to obstruction of its inlet and outlet. A disproportionately large communicating fourth ventricle (DLCFV) is a rare subtype of IFV, characterized by dilation of the fourth ventricle, regardless of the size of the lateral ventricles, with no apparent obstruction of the cerebral aqueduct. To our knowledge, this is the first case series describing endoscopic diagnosis and treatment strategy for DLCFV. We retrospectively reviewed six cases of DLCFV in which endoscopic surgery was performed at our institution and affiliated facilities between June 2013 and March 2017. DLCFV was diagnosed using radiographic imaging and intraoperative endoscopy. We also conducted a PubMed search and included only original studies related to DLCFV treatment written in English in our review of the literature. Endoscopic third ventriculostomy (ETV) was performed in all patients. Additional endoscope-assisted placement of a fourth ventriculoperitoneal (VP) shunt was performed in two patients who could not be managed with ETV alone because of severe adhesion of the interpeduncular cistern due to subarachnoid hemorrhage (SAH). The patients' symptoms and the size of the fourth ventricle improved with surgical treatment, without complications. Endoscopic surgery for DLCFV appears to be a safe and effective treatment. Based on our treatment strategy, ETV is the first-line treatment for DLCFV. Endoscope-assisted placement of the fourth VP shunt can be treatment for severe adhesion of the interpeduncular cistern.
孤立性第四脑室（IFV）的特征是由于其入口和出口的阻塞导致第四脑室扩张。不成比例的大交通性第四脑室（DLCFV）是 IFV 的一种罕见亚型，其特征是第四脑室扩张，无论侧脑室大小如何，而脑导水管无明显阻塞。据我们所知，这是首例描述 DLCFV 的内镜诊断和治疗策略的病例系列。我们回顾性分析了 2013 年 6 月至 2017 年 3 月期间在我院及附属医院行内镜手术治疗的 6 例 DLCFV 患者。DLCFV 通过影像学和术中内镜诊断。我们还进行了 PubMed 检索，仅纳入了关于 DLCFV 治疗的英文原始研究进行文献复习。所有患者均行内镜第三脑室造瘘术（ETV）。2 例患者因蛛网膜下腔出血（SAH）导致脚间池严重粘连，单纯 ETV 无法治疗，因此行内镜辅助下第四脑室-腹腔（VP）分流术。患者症状和第四脑室大小在手术治疗后均得到改善，无并发症发生。内镜手术治疗 DLCFV 似乎是一种安全有效的治疗方法。根据我们的治疗策略，ETV 是 DLCFV 的一线治疗方法。内镜辅助下第四脑室 VP 分流术可治疗脚间池严重粘连。
