CAJ | 학술논문

目的总结软性神经内镜下个性化手术治疗第四脑室流出道梗阻的指证、方法及效果.方法对应用软性神经内镜个性化手术治疗第四脑室流出道梗阻32例患者的临床资料进行回顾性分析.结果单纯第四脑室正中孔造瘘9例,第四脑室正中孔造瘘加第三脑室底造瘘5例,导水管成形加第三脑室底造瘘5例,导水管成形加第四脑室正中孔造瘘2例,单纯第三脑室底造瘘11例.术后脑脊液电影检查显示导水管区脑脊液流动良好26例,枕大孔区第四脑室正中孔脑脊液流动良好10例,第三脑室底瘘口脑脊液流动良好15例,脑脊液电影检查结果不满意但临床症状缓解者2例,术后仍有高颅压表现者5例,其中2例经脑脊液外引流数日后缓解,3例复行脑室-腹腔分流术.所有患者无明显手术并发症出现.结论软性内镜下可以经额部锁孔导水管入路对第四脑室流出道梗阻进行个性化手术治疗,使部分患者恢复正常脑脊液循环,摆脱分流依赖,但应严格选择手术指证.
목적 총결연성신경내경하개성화수술치료제사뇌실류출도경조적지증、방법급효과.방법 대응용연성신경내경개성화수술치료제사뇌실류출도경조32례환자적림상자료진행회고성분석.결과 단순제사뇌실정중공조루9례,제사뇌실정중공조루가제삼뇌실저조루5례,도수관성형가제삼뇌실저조루5례,도수관성형가제사뇌실정중공조루2례,단순제삼뇌실저조루11례.술후뇌척액전영검사현시도수관구뇌척액류동량호26례,침대공구제사뇌실정중공뇌척액류동량호10례,제삼뇌실저루구뇌척액류동량호15례,뇌척액전영검사결과불만의단림상증상완해자2례,술후잉유고로압표현자5례,기중2례경뇌척액외인류수일후완해,3례복행뇌실-복강분류술.소유환자무명현수술병발증출현.결론 연성내경하가이경액부쇄공도수관입로대제사뇌실류출도경조진행개성화수술치료,사부분환자회복정상뇌척액순배,파탈분류의뢰,단응엄격선택수술지증.
Objective To summarize the indication,method and effect of individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet.Methods The clinical data of 32 cases of obstruction of fourth ventricle outlet treated by individual flexible endoscopic procedure from July,2006 to June,2010 were analyzed retrospectively.Results Single endoscopic fourth ventriculostomy (EFV) was performed in 9 cases,EFV with endoscopic third ventriculostomy (ETV) in 5 cases,endoscopic aquductoplasty (EAP) with ETV in 5 cases,EAP with EFV in 2 cases,and single ETV in 11 cases.In cine phase- contrast magnetic resonance imaging( cine - MRI),26 (81.3％) cases showed fine circulation of CSF in aqueduct,10 (31.3％) fine circulation of CSF in Magendie's foramen and 15 (46.9％ ) fine circulation of CSF in the orificium fistulae of third ventricle floor.2 (6.3％ ) cases were symptomatic relief although unsatisfactory result appeared in postoperative cine - MRI.Of 5 ( 15.6％ ) cases who still suffered from postoperative intracranial hypertension,2 (6.3％ ) cases were released by external ventricle drainage for several days,3 (9.4％ ) cases had to had ventriculoperitoneal (VP) shunt because the intracranial hypertension could not be released.There was no complication related to operation appeared in all patients.Conclusions The obstruction of fourth ventricle outlet could be treated individually through trans - aqueduct approach via frontal key - hole with flexible neuroendoscope.Regular CSF circulation could be put back with shunt - free in partial patients,but the operative indication should be obeyed strictly.