Cinalli G, Salazar C, Mallucci C, Yada J Z, Zerah M, Sainte-Rose C
Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Université René Decartes, Paris, France.
Neurosurgery. 1998 Dec;43(6):1323-7; discussion 1327-9. doi: 10.1097/00006123-199812000-00030.
To evaluate the effectiveness of third ventriculostomy as an alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus.
All of the clinical notes of 30 patients treated with third ventriculostomy for malfunctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third ventriculostomy was performed under fluoroscopic control in the first seven patients and endoscopically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years
Twenty-three patients (76.7%) experienced successful outcomes, resulting in shunt independence. Of the seven failures, three were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revision. There have been no delayed failures.
Third ventriculostomy is a valuable alternative to shunt revision in patients affected by obstructive hydrocephalus presenting with shunt malfunction or infection. It should be considered in all suitable cases as the first-line treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these successes will be durable.
评估第三脑室造瘘术作为分流术修复的替代方法，用于治疗梗阻性脑积水的分流故障和感染的有效性。
回顾性分析1974年1月1日至1996年12月31日期间接受第三脑室造瘘术治疗分流故障或感染的30例患者的所有临床记录。前7例患者在荧光镜控制下进行第三脑室造瘘术，其余患者在内镜下进行。如果避免了进一步的分流修复手术，则认为治疗成功。中位随访时间为8.7年。
23例患者（76.7%）治疗成功，无需分流。7例失败患者中，3例为手术时的技术失败，其余4例在中位时间10天内出现，需要进行分流修复。没有出现延迟性失败。
对于出现分流故障或感染的梗阻性脑积水患者，第三脑室造瘘术是分流修复的一种有价值的替代方法。在所有合适的病例中，应将其作为各种原因引起的梗阻性脑积水的一线治疗方法。由于所有失败均在短时间内出现，这些成功可能是持久的。
