论文部分内容阅读
目的 :从三脑室底部造瘘术的经验总结 ,提高梗阻性脑积水的疗效。方法 :1996年 1月至 1999年 12月 ,我科共实施立体定向三脑室底部造瘘术治疗梗阻性脑积水 19例。术前均作 MRI检查 ,鞍背与脑干之间距离大于5 m m,梗阻原因为导水管狭窄 14例 ,松果体区肿瘤 3例 ,三脑室后部肿瘤 2例。全部病例均在 L eksell- G型定向仪辅助下 ,MRI导向 ,应用德国生产的 Storz硬质神经内窥镜 ,由右额钻孔右侧侧脑室入路。根据术中内窥镜下脑室内解剖结构 ,参考立体定向靶点坐标及轨迹 ,选择造瘘口位置。造瘘口一般位于鞍背后方 ,两个乳头体前方 ,用单极电凝器电凝后 ,穿通之 ,再用球囊导管扩大造瘘口 ,直径在 6～ 8mm之间。结果 :全组病人造瘘成功 ,造瘘口未见出血。术后高颅压症状缓解明显。术后 1周颅脑 CT复查显示脑室系统缩小不明显 ,一个月后可见明显缩小 ,但是有1例病人术后二周不但未见缩小 ,反而有所扩大 ,再行 V— P分流术。全组无死亡率。结论 :立体定向辅助下内窥镜作三脑室底部造瘘术 ,具有定位准确 ,手术安全 ,疗效确切的特点。用单极电凝穿通三脑室底部及球囊导管扩张造瘘 ,瘘口形成可靠。
Objective: To summarize the experience of ostomy at the base of the third ventricle to improve the curative effect of obstructive hydrocephalus. Methods: From January 1996 to December 1999, 19 cases of obstructive hydrocephalus were treated with stereotactic three ventricle base ostomy in our department. MRI was performed before surgery, the distance between the saddle and the brainstem is greater than 5 m, obstruction due to aqueduct stenosis in 14 cases, 3 cases of pineal region tumor, 3 cases of posterior tricuspid tumor in 2 cases. All cases were guided by MRI with the aid of L eksell-G orientation instrument. Storz rigid endoscopic endoscopy was performed in Germany and the right lateral ventricle was drilled from the right forehead. According to intraoperative endoscopic anatomy of the ventricle, reference stereotactic target coordinates and trajectory, select the stoma location. The fistula is usually located in the back of the saddle, the front of the two nipples, with monopolar coagulation device electrocoagulation, through, and then expand the catheter with a balloon catheter, the diameter of 6 ~ 8mm. Results: The fistula was successful in all the patients and no bleeding was found in the fistula. Postoperative intracranial pressure relieved significantly. 1 week after craniocerebral CT examination showed that ventricular system is not significantly reduced, a month after the visible shrinkage, but 1 patient not only did not shrink after two weeks, but has been expanded, and then V-P shunt. No death rate in the whole group. Conclusion: Stereotaxic assisted endoscopic surgery for the bottom of the third ventricle fistulation, with accurate positioning, safe operation, the exact effect of the characteristics. Unipolar electrocoagulation through the third ventricle and balloon catheter expansion at the fistula, the formation of reliable fistula.