Kobayashi N, Kamikawa S, Miyake S, Yamamoto K, Kojima N, Tamaki N
Department of Neurosurgery, Kobe Children's Hospital.
No Shinkei Geka. 1997 Jan;25(1):35-40.
Hydrocephalus is usually treated by placing an extracranial CSF shunt. Endoscopic third ventriculostomy, however, has been revived recently as a less invasive method for treatment. We intended to avoid shunting or to eliminate the previously placed shunt with this procedure. The authors review their experiences on third ventriculostomy employing a flexible neuroendoscope under video monitoring in 14 cases of pediatric hydrocephalus. The result was that we succeeded in 11 cases (79%) by third ventriculostomy alone; we avoided shunting in 8 cases and eliminated a previously placed shunt in 3 cases. Clinical summary is shown on Table 1, and illustrative cases are presented with the figures and legend. The patients' group consisted of 8 males and 6 females. Their age ranged from 1 month to 17 years (average age, 6 yr) old. Background diseases of hydrocephalus were brain tumor in 6 cases, Chiari type I malformation in 3, intraventricular hemorrhage in 3, neonatal meningitis in 1 and arachnoid cyst in 1 case. In the remaining 3 cases, however, we failed to avoid the necessity of placing shunt because of indirect reasons (recurrence of tumor, infection after another operation, subdural fluid collection). There was no major complication in relation to third ventriculostomy, except for a moderate elevation of temperature of several days' duration following the procedure. Indication and outcome of this operation is also discussed. Endoscopic third ventriculostomy is an efficacious procedure for the treatment of hydrocephalus in selected patients.
脑积水通常通过放置颅外脑脊液分流管进行治疗。然而，近年来，内镜下第三脑室造瘘术作为一种侵入性较小的治疗方法得以复兴。我们试图通过该手术避免分流或移除先前放置的分流管。作者回顾了他们在视频监测下使用软性神经内镜对14例小儿脑积水患者进行第三脑室造瘘术的经验。结果是，仅通过第三脑室造瘘术我们就成功了11例（79%）；我们避免了8例患者的分流，并移除了3例患者先前放置的分流管。临床总结见表1，并配有插图和图例展示典型病例。患者组包括8名男性和6名女性。他们的年龄从1个月到17岁不等（平均年龄6岁）。脑积水的背景疾病包括6例脑肿瘤、3例Chiari I型畸形、3例脑室内出血、1例新生儿脑膜炎和1例蛛网膜囊肿。然而，在其余3例中，由于间接原因（肿瘤复发、另一次手术后感染、硬膜下积液），我们未能避免放置分流管的必要性。除了术后几天体温适度升高外，第三脑室造瘘术没有重大并发症。本文还讨论了该手术的适应症和结果。内镜下第三脑室造瘘术对部分脑积水患者是一种有效的治疗方法。
