Wasi Muhammad Samir Irfan, Sharif Salman, Shaikh Yousuf
Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom.
Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
Asian J Neurosurg. 2020 Oct 19;15(4):926-930. doi: 10.4103/ajns.AJNS_161_20. eCollection 2020 Oct-Dec.
Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image guidance while planning a trajectory can reduce the incidence of complications as it significantly alters the usual approach for ETV, i.e., the coronal burr hole can be useful for young neurosurgeons to overcome the learning curve associated with the procedure.
This is a prospective, observational study conducted at Liaquat National Hospital. In this study, 43 patients were included who underwent ETV for hydrocephalus. Complications were divided into three major groups: arterial hemorrhage, venous hemorrhage, and injury to neural structures (fornix, hypothalamus, and oculomotor nerve). The data were compared with studies showing the complications of ETV with and without usage of image guidance.
Among the 43 patients who underwent ETV with image guidance, only two patients (4.65%) had iatrogenic fornix contusions. Neither of them developed memory impairment. None of the patients (0%) encountered other major iatrogenic complications, including injury to the mammillary body, basilar artery, or oculomotor nerve.
The use of image guidance can reduce trajectory-related complications, including hemorrhage and iatrogenic injuries to the fornix. This study showed that the altered trajectory was beneficial in avoiding major neurological structures while introducing an endoscope through the cortex into the ventricular system.
世界各地的神经外科医生都在进行内镜下第三脑室造瘘术（ETV）来治疗脑积水。ETV会引发多种并发症，其中最严重的是对穹窿的医源性损伤。我们旨在证实，在规划手术路径时使用图像引导可以降低并发症的发生率，因为它显著改变了ETV的常规手术方法，即冠状钻孔对年轻神经外科医生克服与该手术相关的学习曲线可能有用。
这是在利亚卡特国家医院进行的一项前瞻性观察研究。本研究纳入了43例因脑积水接受ETV手术的患者。并发症分为三大类：动脉出血、静脉出血和神经结构（穹窿、下丘脑和动眼神经）损伤。将这些数据与显示有无使用图像引导的ETV并发症的研究进行比较。
在43例接受图像引导下ETV手术的患者中，只有2例（4.65%）发生了医源性穹窿挫伤。他们均未出现记忆障碍。没有患者（0%）遇到其他主要的医源性并发症，包括乳头体、基底动脉或动眼神经损伤。
使用图像引导可减少与手术路径相关的并发症，包括出血和对穹窿的医源性损伤。本研究表明，改变后的手术路径在通过皮层将内窥镜引入脑室系统时有利于避开主要神经结构。
