Endoscopic Third Ventriculostomy in the Management of Obstructive Hydrocephalus Caused by Aqueductal Stenosis

內視鏡第三腦室造口術治療大腦導水管狹窄所引起的阻塞性水腦症

羅永欽(Joon-Khim Loh) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 16卷10期 (2000/10) Pp. 510-516

https://doi.org/10.6452/KJMS.200010.0510

摘要

長期的使用顱外分流手術治療水腦症病人所產生的合併症很多如分流管功能不全和感染，近年來有一篇文獻報告有1719位水腦症病人接受顱外分流手術經12年長期追蹤後發現高達81%病人因合併症需再接受第二次甚至第三次手術治療，且因合併症而死亡的病人有1.05%。本篇報告我們成功的使用軟式內視鏡做第三腦室造口術治療21位因大腦導水管狹窄所引起阻塞性水腦症病人。術後病人無不良的合併症也無死亡病例，且有95.2%病人獲得良好的結果。經長期的追蹤大部份病人不需再接受顱外分流手術的治療，我們所得到的成績優於以前的文獻報告。使用軟式內視鏡手術是一種簡單而安全的治療，術中可讓我們清楚的看到腦室內的構造，如內有腫瘤亦可做切片檢查。因此對於因大腦導水管狹窄所引起阻塞性水腦症的病人我們建議以內視鏡第三腦室造口術治療為第一優先。

並列摘要

Long-term extracranial shunting for hydrocephalus has numerous draw backs related to shunt malfunction and infection. The outcomes have been very disappointing in some cases. We have treated twenty one patients with obstructive hydrocephalus, without mortality or morbidity, using a flexible endocope to perform third ventriculostomy. Favorable outcomes were achieved in 95.2% of the cases. Our results are superior to those previously reported. Most of the patients remained shunt independent after treatment and had ob tained long-term stabilization. Flexible endoneurosurgical management is simple and safe, and it allows in situ observation and performance of biopsies. Therefore, in patients with obstructive hydrocephalus due to aqueductal stenosis, endoscopic third ventriculostomy should be seriously considered as the primary surgical management.

並列關鍵字

endoscopic third ventriculostomy； aqueductal stenosis； hydrocephalus