神经导航内镜导水管成形术联合脑室-终板造瘘术治疗伴有脊髓脊膜膨出的复杂脑积水和脊髓空洞症孤立第四脑室：我的方法。
Neuronavigated endoscopic aqueductoplasty with panventricular stent plus septostomy for isolated fourth ventricle in complex hydrocephalus and syringomyelia associated with myelomeningocele: how I do it.
机构信息
Department of Neurosurgery, Torrecárdenas University Hospital, Calle Hermandad Donantes de Sangre s, /n 04009, Almería, Spain.
Department of Health Science, University of Almería, Almería, Spain.
出版信息
Acta Neurochir (Wien). 2023 Aug;165(8):2333-2338. doi: 10.1007/s00701-023-05649-9. Epub 2023 Jun 7.
BACKGROUND
Isolated fourth ventricle (IFV) is a challenging entity to manage. In recent years, endoscopic treatment for aqueductoplasty has been on the rise. However, in patients with complex hydrocephalus and distorted ventricular system, its implementation can be complex.
METHODS
We present a 3-year-old patient with myelomeningocele and postnatal hydrocephalus treated by ventriculoperitoneal shunt. In follow-up, a progressive IFV and isolated lateral ventricle with symptoms of the posterior fossa developed. An endoscopic aqueductoplasty (EA) with panventricular stent plus septostomy guided with neuronavigation was decided due to the complexity of the ventricular system.
CONCLUSION
In IFV associated with complex hydrocephalus with distortion of the ventricular system, navigation can be of great help for planning and as a guide for performing EA.
背景
孤立第四脑室（IFV）是一种具有挑战性的疾病，近年来，神经内镜下三脑室底造瘘术治疗导水管狭窄已逐渐增多，但对于复杂脑积水、脑室系统变形的患者，其实施可能较为复杂。
方法
我们报告了一例 3 岁的脊髓脊膜膨出伴发脑积水患儿，行脑室腹腔分流术后，随访中发现进行性孤立第四脑室形成，合并孤立的外侧脑室，且出现后颅窝症状。由于脑室系统的复杂性，决定采用神经导航辅助内镜下三脑室底造瘘术（EA）联合全脑室支架加室间孔切开术。
结论
在复杂脑积水伴脑室系统变形导致的孤立第四脑室中，导航可有助于规划和指导 EA 的实施。
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