Yamane K, Yoshimoto H, Harada K, Uozumi T, Kuwabara S
No Shinkei Geka. 1983 May;11(5):491-7.
Spontaneous ventriculocisternostomy rarely occurs in obstructive hydrocephalus. The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300 mmH2O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. In the literature, arrest of hydrocephalus was noted in 50 per cent of 14 cases of obstructive hydrocephalus with spontaneous ventriculocisternostomy. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy.
自发性脑室脑池造瘘术在梗阻性脑积水患者中很少发生。作者经历了1例经甲泛葡胺和康瑞（碘酞葡胺）CT扫描确诊的自发性脑室脑池造瘘术病例。患者为23岁男性，入院前1个月一直身体健康，之后开始出现头痛和耳鸣。入院前约1周他发现双侧视力下降，入院前2天出现呕吐。因双侧视乳头水肿及CT扫描诊断为明显脑积水而入院。入院时，除双侧视乳头水肿外未发现异常神经体征。立即进行了右心室引流。脑室压力超过300 mmH2O，脑脊液清澈。脑室造影和脑池造影显示第三脑室后方有另一个腔隙，与第三脑室相通，中脑导水管闭塞。甲泛葡胺CT扫描和碘酞葡胺CT扫描显示该腔隙与四叠体池和小脑上池相通。根据这些神经放射学表现，诊断为良性导水管狭窄伴自发性脑室脑池造瘘术所致梗阻性脑积水。自发性脑室脑池造瘘术被认为可使脑积水停止，但在我们的病例中，此类症状并未出现自发性消退。在文献中，14例梗阻性脑积水伴自发性脑室脑池造瘘术患者中有50%出现脑积水停止。通过外科脑室脑池造瘘术（托尔基尔德森法、丹迪法或斯卡夫法），约50%至70%的患者出现脑积水停止，这与自发性脑室脑池造瘘术的结果相同。结论是，对于梗阻性脑积水，脑室腹腔分流术或脑室心房分流术被认为比各种外科脑室脑池造瘘术更好。
