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Clinical technique probing for endoscopic third ventriculostomy (ETV)

发表时间:2008-05-15 发表者:神经外科 (访问人次:1067)

XU Yongge

Abstracts: Objective To probe into the techniques of endoscopic third ventriculostomy (ETV) for the treatment of non-communicating hydrocephalus. Method Early clinical follow-up results and imaging data of 58 ETVs in 58 patients with non-communicating hydrocephalus were evaluated retrospectively. Results Fifty-eight patients, 35 male, 23 femalefollowed up for a mean of 9.8 months (ranged form 3 to 18 months). After ETVs, forty-nine (84.5%) of the patients exhibited distinct improvements, seven (12.1%) displayed no change, and two (3.4%) demonstrated worsen. Clinically; Fifty-one patients followed up by CT or MRI scanning. Of 41 patients (80.4%), the hydrocephalus improved with narrowed third ventricles; of 15 patients (29.4%), the hydrocephalus showed no changes; of the last 2 patients (3.4%), the hydrocephalus aggravated and then the patients accepted V-P shunts. Complications occurred in 8 cases (13.9%) with 8 kinds and 14 times. Most of them were in short duration; there were no death correlated with ETVs, and only 2 cases (3.4%) deemed permanent serious defects. Conclusions ETV for the treatment of non-communicating hydrocephalus was efficacious. To reduce the complication rate, knowing the anatomy of ventricles intimately and practiced neuroendoscopic manipulation are very important. The correct choice of head positionbone hole positionthe endoscope direction and the position of fenestration of third ventricle floor are all important factors for the succeed ETVs. The Liliequist membrane must be opened when it was found in interpeduncular cistern. The cortical tunnel defect must be sealed off after the endoscope pulled out. It is also important to emphasize hemostasis and aseptic manipulation during the operation.

 

Key wordsneuroendoscopyminimal invasive neurosurgeryhydrocephalusnon-communicationendoscopic third ventriculostomyETV

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