Oka K, Yamamoto M, Ikeda K, Tomonaga M
Department of Neurosurgery, Fukuoka University School of Medicine, Japan.
Neurosurgery. 1993 Aug;33(2):236-42; discussion 242-3. doi: 10.1227/00006123-199308000-00009.
We successfully managed 11 patients with aqueductal stenosis of adult or adolescent onset, with no mortality or significant morbidity, by using a flexible ventriculoscope to perform either a third ventriculostomy or an aqueductal plasty. A flexible fiberoptic ventriculoscope and its accessories were newly developed, and surgical techniques were improved. For all patients, cinemagnetic resonance imaging was a critical part of the preoperative and postoperative evaluation of cerebrospinal fluid flow in the third ventricle and in the aqueduct of Sylvius. All of the 11 patients showed patency to cerebrospinal fluid flow at the aqueduct of Sylvius and the floor of the third ventricle. Only one patient subsequently required a lumboperitoneal shunt. Flexible endoneurosurgical management is simple and safe and allows in situ observation and the ability to perform biopsies. Therefore, flexible endoneurosurgical third ventriculostomy and aqueductal plasty are now considered our treatment of choice for aqueductal stenosis in adults and adolescents.
我们通过使用可弯曲脑室镜进行第三脑室造瘘术或导水管成形术，成功治疗了11例成人或青少年期发病的导水管狭窄患者，无一例死亡或出现严重并发症。一种新型的可弯曲光纤脑室镜及其附件被研发出来，手术技术也得到了改进。对于所有患者，电影磁共振成像在术前和术后评估第三脑室及中脑导水管的脑脊液流动情况中起到了关键作用。11例患者中，所有患者的中脑导水管及第三脑室底部的脑脊液流动均通畅。只有1例患者随后需要进行腰大池腹腔分流术。可弯曲神经内镜手术操作简单、安全，能够进行原位观察并可取组织活检。因此，可弯曲神经内镜下第三脑室造瘘术和导水管成形术目前被认为是我们治疗成人和青少年导水管狭窄的首选方法。
