Krejčí Ondřej, Krejčí Tomáš, Mrůzek Michael, Večeřa Zdeněk, Šalounová Dana, Lipina Radim
Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
World Neurosurg. 2021 Apr;148:e425-e435. doi: 10.1016/j.wneu.2021.01.008. Epub 2021 Jan 12.
Primary fourth ventricle outlet obstruction (PFVOO) is a rare cause of hydrocephalus with an unclear etiopathogenesis, and thus, consensus regarding the recommended treatment protocol is lacking. This study aims to summarize current knowledge of this condition in the light of our own treatment experience.
Retrospective analysis was carried out of all patients treated for noncommunicating tetraventricular hydrocephalus between 2006 and 2019, from which a subgroup of patients with PFVOO was created. A literature review of PFVOO cases was also carried out.
A total of 62 patients with PFVOO were discovered, of whom 8 were treated at our institution, representing 3.8% of our patients with noncommunicating hydrocephalus. Patients most commonly presented with headaches, gait disturbance, or symptoms of intracranial hypertension. The mean follow-up duration was 75.4 months among our patients and 29.9 months in the literature. Most patients (54.8%) were treated by endoscopic third ventriculostomy (ETV), with the remainder undergoing suboccipital craniotomy alone (17.7%) or in combination with shunt surgery (9.7%), or endoscopic magendieplasty (12.9%). Treatment failure was noted in 28.6% of ETVs and 9% of craniotomies. No failures were recorded after endoscopic magendieplasty. The risk of treatment failure was found to be significantly higher with ETV compared with other treatment modalities (P < 0.0005).
Despite the fact that PFVOO can be defined as an obstructive hydrocephalus, there seems to be a higher risk of ETV failure in such cases. The alternative treatment modalities presented are still recommended. Confirmation of these findings requires a larger multicenter study.
原发性第四脑室出口梗阻（PFVOO）是脑积水的一种罕见病因，其发病机制尚不清楚，因此，对于推荐的治疗方案缺乏共识。本研究旨在根据我们自己的治疗经验总结对这种疾病的现有认识。
对2006年至2019年间所有接受非交通性四脑室脑积水治疗的患者进行回顾性分析，从中创建PFVOO患者亚组。还对PFVOO病例进行了文献综述。
共发现62例PFVOO患者，其中8例在我们机构接受治疗，占我们非交通性脑积水患者的3.8%。患者最常见的表现为头痛、步态障碍或颅内高压症状。我们的患者平均随访时间为75.4个月，文献中的平均随访时间为29.9个月。大多数患者（54.8%）接受了内镜下第三脑室造瘘术（ETV），其余患者单独接受枕下开颅手术（17.7%）或联合分流手术（9.7%），或内镜下马根迪孔成形术（12.9%）。ETV治疗失败率为28.6%，开颅手术治疗失败率为9%。内镜下马根迪孔成形术后未记录到失败病例。与其他治疗方式相比，ETV治疗失败的风险显著更高（P<0.0005）。
尽管PFVOO可被定义为梗阻性脑积水，但在这种情况下，ETV失败的风险似乎更高。仍推荐所介绍的替代治疗方式。这些发现需要更大规模的多中心研究来证实。
