Lee M, Leahu D, Weiner H L, Abbott R, Wisoff J H, Epstein F J
Division of Pediatric Neurosurgery, New York University Medical Center, New York 10016, USA.
Pediatr Neurosurg. 1995;22(6):309-13; discussion 314. doi: 10.1159/000120921.
Fourth-ventricular shunting is commonly used to treat symptomatic posterior fossa cysts of the Dandy-Walker malformation and trapped fourth ventricle. Although the benefits of this procedure have been widely reported, there is a paucity of data on the pitfalls of posterior fossa shunting in the neurosurgical literature. During the 4-year period from July 1989 to June 1993, we placed fourth-ventricular shunts in 12 patients. Remarkably, 5 patients suffered complications related to posterior fossa catheter placement (42% rate). Three of these patients developed new cranial nerve dysfunction caused by direct injury to the floor of the fourth ventricle, 1 patient suffered an intracystic hemorrhage and acute shunt malfunction, and 1 patient had the catheter tip in the brainstem on postoperative studies without new neurological deficit. We conclude that placement of fourth-ventricular shunts can be fraught with complications which we believe is related to technique. We propose that altering the trajectory of the ventricular catheter from our usual midline technique to a more lateral position will lessen the chances for injury to the floor of the fourth ventricle. In this manner we hope to decrease our incidence of complications for this procedure.
第四脑室分流术常用于治疗丹迪-沃克畸形和第四脑室受压的有症状的后颅窝囊肿。尽管该手术的益处已被广泛报道，但神经外科文献中关于后颅窝分流术陷阱的数据却很匮乏。在1989年7月至1993年6月的4年期间，我们为12例患者进行了第四脑室分流术。值得注意的是，5例患者出现了与后颅窝导管置入相关的并发症（发生率为42%）。其中3例患者因第四脑室底部直接损伤出现了新的颅神经功能障碍，1例患者发生囊内出血和急性分流故障，1例患者术后检查发现导管尖端位于脑干，但无新的神经功能缺损。我们得出结论，第四脑室分流术的置入可能充满并发症，我们认为这与技术有关。我们建议将脑室导管的轨迹从我们通常的中线技术改为更外侧的位置，以减少第四脑室底部受伤的机会。通过这种方式，我们希望降低该手术的并发症发生率。
