Hirsch J F, Hirsch E, Sainte Rose C, Renier D, Pierre-Khan A
J Neurosurg Sci. 1986 Jan-Jun;30(1-2):29-39.
Etiology, mechanism and treatment remain controversial in aqueductal stenosis. The review of 114 cases operated on between 1975 and 1982 in the Service of Pediatric Neurosurgery of "Les Enfants-Malades" in Paris was undertaken with the hope of improving our understanding of these problems. Toxoplasmosis was in our series the most frequent etiology, accounting for 15% of the cases; 74% of the aqueductal stenoses in this series were of unknown origin. In two cases, a small arachnoid cyst, developed in contact with the ambient cistern, was the cause of the aqueductal stenosis. In about half of the 32 pneumoencephalograms performed, a rounded, dilated ambient cistern was found. No such dilatation was observed in 35 pneumoencephalograms performed in cases of communicating hydrocephalus. It is likely that some cases of aqueductal stenoses are the consequence of a compression of the brain stem by an overpressurized ambient cistern, whether communicating or not with the subarachnoid spaces. Although the ventricular volume is less reduced after percutaneous ventriculostomy than after shunting, the long term results of the two treatments are comparable. The risk of infection is lower with ventriculostomies, but the rate of failures is higher. Since ventriculocisternostomy is a safe procedure when patients are properly selected, it can be tested first, a shunt being inserted at a later time in case of failure.
导水管狭窄的病因、机制及治疗仍存在争议。对1975年至1982年间在巴黎“患病儿童”儿科神经外科接受手术的114例病例进行回顾，以期增进我们对这些问题的理解。在我们的系列病例中，弓形虫病是最常见的病因，占病例的15%；该系列中74%的导水管狭窄病因不明。在两例病例中，与环池接触处出现的小蛛网膜囊肿是导水管狭窄的原因。在进行的32次气脑造影中，约一半发现环池呈圆形、扩张。在交通性脑积水病例中进行的35次气脑造影中未观察到这种扩张。很可能某些导水管狭窄病例是由于压力过高的环池压迫脑干所致，无论其是否与蛛网膜下腔相通。虽然经皮脑室造瘘术后脑室容积缩小程度小于分流术后，但两种治疗的长期效果相当。脑室造瘘术的感染风险较低，但失败率较高。由于脑室-脑池造瘘术在患者选择合适时是一种安全的手术，因此可以先进行试验，如失败则在以后插入分流管。
