Sokol Zachary, Gupta Rohan V, Ziechmann Robert, Shepard Scott R
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
J Neurosurg Case Lessons. 2024 Dec 9;8(24). doi: 10.3171/CASE24478.
Endoscopic third ventriculostomy (ETV) is an effective procedure for the treatment of triventriculomegaly associated with aqueductal stenosis. However, some patients can develop severe and symptomatic intracranial pressure (ICP) elevations in the immediate postoperative period that can be monitored and treated with external ventricular drain (EVD) placement and controlled cerebrospinal fluid (CSF) diversion until the ICP normalizes and symptoms resolve.
The authors describe the case of a 39-year-old male who underwent ETV and intraoperative EVD placement for obstructive hydrocephalus associated with aqueductal stenosis. The patient was noted to have sustained ICP elevations in the immediate perioperative period but ultimately experienced a successful clinical outcome without requiring a ventriculoperitoneal shunt.
Significant sustained ICP elevations in the immediate postoperative period following ETV can occur and may indicate a prolonged adjustment period. These elevations can be tolerated if the patient's symptoms and ICP are well controlled, with temporary external CSF diversion if the patient becomes symptomatic, as the ICP will likely normalize with a reassuring clinical outcome. https://thejns.org/doi/10.3171/CASE24478.
内镜下第三脑室造瘘术（ETV）是治疗与导水管狭窄相关的三脑室扩大的有效方法。然而，一些患者在术后即刻可能出现严重且有症状的颅内压（ICP）升高，可通过放置外部脑室引流管（EVD）并控制脑脊液（CSF）引流来监测和治疗，直至ICP恢复正常且症状缓解。
作者描述了一名39岁男性的病例，该患者因导水管狭窄相关的梗阻性脑积水接受了ETV及术中EVD放置。该患者在围手术期即刻出现持续性ICP升高，但最终获得了成功的临床结局，无需进行脑室腹腔分流术。
ETV术后即刻可能出现显著的持续性ICP升高，这可能表明调整期延长。如果患者的症状和ICP得到良好控制，这些升高是可以耐受的；如果患者出现症状，则可进行临时外部CSF引流，因为ICP可能会恢复正常并获得令人放心的临床结局。https://thejns.org/doi/10.3171/CASE24478
