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目的:研究神经内镜治疗脑积水的效果、适应症和手术技巧。方法:2001年来,共采用神经内镜治疗脑积水10例,其中神经内镜三脑室造瘘术(ETV)6例,神经内镜透明膈造瘘术1例,因室间孔狭小或视野不清改行脑室-腹腔分流术3例。分析其临床和影像学结果,总结其效果、适应症和手术技巧。结果:行ETV的6例术后颅内压210～240mmH2O(226mmH2O±28mmH2O)。1例松果体区转移瘤患者在行脑室-腹腔分流术后未行进一步治疗,术后3月死亡。其余9例症状好转,影像学复查脑室缩小的6例。并发脑膜炎1例,发热2例,其中1例为1.5岁小儿因全麻并发急性喉炎,另1例原因不明,3天后好转。1例切口愈合不良,后经二期清创、缝合后治愈。4例ETV术后并发头皮下少量积液,自行好转。出血2例,经温Ringer’s液冲洗后出血停止。无死亡和永久后遗症。结论:本组取得了良好的近期效果,无死亡和永久后遗症。对于因导水管狭窄、后颅窝和中脑占位引起的梗阻性脑积水患者ETV有很好的效果。良性占位病变的大多数可获得良好的效果,但要尽早处理原发病变。慎重选择造瘘部位和器械对于避免出血等严重并发症有重要意义。
Objective: To study the effect of endoscopic treatment of hydrocephalus, indications and surgical techniques. Methods: In 2001, a total of 10 cases of hydrocephalus were treated with neuroendoscopy, including 6 cases of endoscopic three ventricle fistulation (ETV) and 1 case of endoscopic translucent phrenic fistula Unconscious to change the ventricle - peritoneal shunt in 3 cases. Analyze its clinical and radiographic findings, summarize its effects, indications and surgical techniques. Results: 6 cases of ETV postoperative intracranial pressure 210 ~ 240mmH2O (226mmH2O ± 28mmH2O). One case of pineal region metastases in patients undergoing intraventricular-peritoneal shunt without further treatment, died after 3 months. The remaining 9 cases improved symptoms, imaging review ventricular contractions in 6 cases. 1 case of meningitis, fever in 2 cases, 1 case of 1.5-year-old children with acute laryngitis due to general anesthesia, and the other one case of unknown cause, improved after 3 days. 1 case of incision healing, after debridement, suture cured. 4 cases of ETV complicated with scalp after a small amount of effusion, self-improvement. Bleeding in 2 cases, after Ringer’s solution rinse stopped bleeding. No death or permanent sequelae. Conclusion: This group has achieved good near-term results with no death or permanent sequelae. ETV for ETV in patients with obstructive hydrocephalus due to narrowing of the aqueduct, posterior fossa and midbrain. The majority of benign space-occupying lesions can achieve good results, but the primary lesion should be treated as soon as possible. Prudent choice of fistula site and equipment for the prevention of bleeding and other serious complications of great significance.