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内镜下第三脑室造瘘术治疗小脑迟发性血肿继发梗阻性脑积水

Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus Secondary to Delayed Intracerebellar Hematoma.

作者信息

Ceja Espinosa Alejandro, Franco Jimenez Jose Alfonso, Reyes Vazquez Paola, Gutierrez Aceves Guillermo Axayacalt, Ponce Ayala Aurelio

机构信息

Department of Vascular Neurosurgery, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, MEX.

Department of Pediatric Neurosurgery, Instituto Materno Infantil del Estado de Mexico, Hospital Para el Niño, Toluca de Lerdo, MEX.

出版信息

Cureus. 2021 Aug 19;13(8):e17302. doi: 10.7759/cureus.17302. eCollection 2021 Aug.

Abstract

Nowadays, endoscopic third ventriculostomy (ETV) in neurosurgery has yielded good clinical results in various conditions. Intraventricular endoscopic procedures can be performed in different pathologies and not only in non-communicating hydrocephalus. This is presented accordingly in this clinical case. We present the case of a patient who suffered a blunt traumatic brain injury (TBI) in the occipital region. Upon his arrival at the medical facility, he displayed altered neurological status and showed symptoms of aggressiveness, slurred speech, and gait ataxia. Initial non-contrast brain computed tomography scan presented a cerebellar traumatic subacute hematoma and secondary hydrocephalus. Therefore, we performed an ETV. In most reported cases of cerebellar contusions among patients with TBI, the treatment was suboccipital craniectomy, clot evacuation, and external ventricular drainage (EVD). Unlike this case, the determined procedure was minimally invasive through ETV for the resolution of hydrocephalus with good clinical outcomes in addition to low morbidity and mortality. This case shows in the setting of delayed intracerebellar traumatic hematoma with secondary hydrocephalus being the main cause of neurological deterioration, a minimally invasive treatment such as ETV is suitable.

摘要

如今,神经外科的内镜下第三脑室造瘘术(ETV)在各种情况下都取得了良好的临床效果。脑室内内镜手术可用于不同的病理情况,而不仅仅是治疗非交通性脑积水。本临床病例将对此进行相应介绍。我们报告一例枕部遭受钝性颅脑损伤(TBI)的患者。患者到达医疗机构时,神经状态改变,表现出攻击性、言语不清和步态共济失调等症状。最初的脑部非增强计算机断层扫描显示小脑创伤性亚急性血肿和继发性脑积水。因此,我们实施了ETV。在大多数报道的TBI患者小脑挫伤病例中,治疗方法是枕下开颅术、清除血肿和脑室外引流(EVD)。与该病例不同的是,所确定的手术通过ETV具有微创性,除了发病率和死亡率低之外,还能有效解决脑积水问题并取得良好的临床效果。该病例表明,在迟发性小脑创伤性血肿且继发性脑积水是神经功能恶化主要原因的情况下,像ETV这样的微创治疗是合适的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ff41/8449540/5ca0861e22f4/cureus-0013-00000017302-i01.jpg

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