中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2010年
5期
441-444
,共4页
郑佳平%梁晖%陈国强%肖庆%冯增伟
鄭佳平%樑暉%陳國彊%肖慶%馮增偉
정가평%량휘%진국강%초경%풍증위
梗阻性脑积水%神经内镜%脑导水管,梗阻性
梗阻性腦積水%神經內鏡%腦導水管,梗阻性
경조성뇌적수%신경내경%뇌도수관,경조성
Obstructive hydrocephalus%Neuroendoscopy%Cerebral aqueduct,obstructive
目的 探讨导水管梗阻所致巨大脑室脑积水手术治疗的指征及并发症预防.方法 神经内镜下共治疗32例巨大脑室脑积水患者,其中25例行经额入路第三脑室底造瘘术,1例行经额小脑上池囊肿造瘘术,5例行枕下入路内镜下后颅窝囊肿切除、囊腔枕大池造瘘,1例行经枕下入路导水管成形术.结果 术后随访1-4年,32例具有行走不稳、尿失禁、智商下降、精神运动发育迟缓的患者中,26例症状明显改善,6例症状未继续进展.6例术前存在高颅压症状患者术后症状改善,除1例出现硬膜下积液外,无其他严重并发症发生.结论 巨大脑室脑积水并非内镜手术治疗禁忌,凡影像检查确定为导水管梗阻所致的巨大脑室脑积水,均应积极手术治疗,改进手术方法 可以避免严重并发症的发生.
目的 探討導水管梗阻所緻巨大腦室腦積水手術治療的指徵及併髮癥預防.方法 神經內鏡下共治療32例巨大腦室腦積水患者,其中25例行經額入路第三腦室底造瘺術,1例行經額小腦上池囊腫造瘺術,5例行枕下入路內鏡下後顱窩囊腫切除、囊腔枕大池造瘺,1例行經枕下入路導水管成形術.結果 術後隨訪1-4年,32例具有行走不穩、尿失禁、智商下降、精神運動髮育遲緩的患者中,26例癥狀明顯改善,6例癥狀未繼續進展.6例術前存在高顱壓癥狀患者術後癥狀改善,除1例齣現硬膜下積液外,無其他嚴重併髮癥髮生.結論 巨大腦室腦積水併非內鏡手術治療禁忌,凡影像檢查確定為導水管梗阻所緻的巨大腦室腦積水,均應積極手術治療,改進手術方法 可以避免嚴重併髮癥的髮生.
목적 탐토도수관경조소치거대뇌실뇌적수수술치료적지정급병발증예방.방법 신경내경하공치료32례거대뇌실뇌적수환자,기중25례행경액입로제삼뇌실저조루술,1례행경액소뇌상지낭종조루술,5례행침하입로내경하후로와낭종절제、낭강침대지조루,1례행경침하입로도수관성형술.결과 술후수방1-4년,32례구유행주불은、뇨실금、지상하강、정신운동발육지완적환자중,26례증상명현개선,6례증상미계속진전.6례술전존재고로압증상환자술후증상개선,제1례출현경막하적액외,무기타엄중병발증발생.결론 거대뇌실뇌적수병비내경수술치료금기,범영상검사학정위도수관경조소치적거대뇌실뇌적수,균응적겁수술치료,개진수술방법 가이피면엄중병발증적발생.
Objective To explore the indications of surgical treatment of ventriculomegaly hydrocephalus caused by primary or secondary aqueduct obstruction and the prevention of complications. Method Endoscopic treatment of 32 cases of overt ventriculomegaly patients in total, 25 cases were subject to transfrontal -approach endoscopic third ventriculostomy, 1 case was subject to SCC cyst fistulation, 5 cases was subject to suboccipital - approach endoscopic skull cranial fossa cyst resection and cyst - cistema magnafistulation and 1 case was subject to suboccipital approach hydrocephalus plasty. Results After 1-4 years of follow - up, among 32 cases of patients of unstable walking, urinary incontinence, decreased intelligence quotient, psychomotor retardation, the symptoms of 26 cases were significantly improved and the symptoms of 6 cases of patients showed no continuous progression. The post - surgical symptoms of the six cases of patients with preoperative high intracranial pressure symptoms were improved. Conclusions The magnetic resonance imaging test shows the aqueduct stenosis or obstruction is a clear indication of patients of overt ventriculomegaly no matter whether there is clinical symptom of intracranial hypertension or not after surgical treatment As long as attentions are paid to the details during the operation process, the improvement of surgical techniques can avoid the occurrence of complications.
