Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK.
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Childs Nerv Syst. 2021 Jan;37(1):101-105. doi: 10.1007/s00381-020-04895-x. Epub 2020 Sep 27.
Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures.
We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed.
28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively.
Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.
脑室神经内镜技术，尤其是第三脑室造瘘术，在婴儿脑积水的治疗中应用越来越多。然而，进入脑室腔的手术会增加术后脑脊液（CSF）漏的风险。在此，我们描述了一种针对伤口切开和缝合的结构化、多层次方法，旨在最大限度地利用天然组织屏障来防止 CSF 漏。我们介绍了一组接受这种技术的患者，并随后回顾了关于儿科脑室神经内镜手术中切开和缝合技术的文献。
我们对一家机构在 5 年内进行的脑室神经内镜手术的 1 岁以下患者进行了回顾性病例系列分析。通过机构手术数据库识别患者，随后对手术记录和临床记录进行回顾。
28 例患者符合本研究的纳入标准。手术时的平均年龄为 9 周。27 例患者接受了内镜第三脑室造瘘术，1 例患者接受了内镜隔切开术，所有患者均接受了我们的结构化、多层次的切开和缝合技术。随访时间从 4 个月到 5 年不等。无术后 CSF 漏、感染或伤口破裂的病例。12 例患者在最后一次随访时仍无需分流，其余 16 例因进行性脑积水在术后平均 24 天需要分流植入。
文献中报道了各种旨在预防术后 CSF 漏的方法。我们提出，我们的机构技术可能有助于在接受内镜第三脑室造瘘术和类似脑室神经内镜手术的婴儿中降低这种风险。
