脑积水内镜下第三脑室底部的形态特征分析

神经内镜下第三脑室底造瘘术（endoscopic

third ventriculostomy ，ETV ）已成为治疗非交通性脑

积水的首选方法，而内镜下第三脑室底的解剖形态直接影响ETV 能否顺利进行。2006年9月-2010年

6月，首都医科大学附属北京世纪坛医院神经外科

采用ETV 治疗脑积水178例，并对第三脑室底的解

剖形态进行回顾性分析，现报道如下。

1对象与方法1.1

临床资料

男117例，女61例；年龄3个月~

68岁。其中幕上脑积水113例，全脑室扩大59例，不对称性脑积水4例，单纯第四脑室积水2例。既往颅内出血13例，颅内感染7例，小脑扁桃体下疝11例，脊柱裂1例。

1.2术前影像学检查术前均行头部脑脊液磁共振电影成像（Cine MRI ）检查，常规测量中脑导水管

入口，第四脑室出口处脑脊液流速、流量，并通过

MRI 正中矢状位图像初步观察第三脑室底部结构。1.3手术方法以中线旁2cm 、冠状缝前1cm 为穿

刺点，双极电凝电灼皮质后脑穿针穿刺脑室，然后置入外径4.2mm 的单工作通道硬质神经内镜（Karl

Storz ，Germany ）。首先探查侧脑室内情况，观察透明

隔是否完整，循丘纹静脉、脉络丛和隔静脉构成的“Y ”形结构找到同侧室间孔，内镜经室间孔进入第三脑室，观察第三脑室底部结构，在两侧乳头体前方、漏斗隐窝后的半透明膜中心处进行造瘘，以组织

·临床研究·

基金项目：北京世纪坛医院科研基金（编号：2008-16，2009-23）作者单位：100038首都医科大学附属北京世纪坛医院神经外科[朱广通、胡志强、黄辉、关峰、戴缤、王邵恒（实习医生）、毛贝贝（实习医生）、任乐宁（实习医生）、康庄（实习医生）]；150001哈尔滨医科大学（王邵恒、毛贝贝、任乐宁、康庄）

通讯作者：胡志强，Email ：neuro7@

脑积水内镜下第三脑室底部的形态特征分析

朱广通，胡志强，黄

辉，关

峰，戴

缤，王劭恒，毛贝贝，任乐宁，康

庄

【摘要】目的研究脑积水第三脑室底部的形态特征，并评估其对内镜下第三脑室底造瘘术（ETV ）的影响。方法回顾性分析178例脑积水病人第三脑室底的形态特征，并探讨其对造瘘过程的影响及相关手术技巧。结果第三脑室底形态改变如下：宽度扩张167例，狭窄2例，正常9例；厚度变薄38例，增厚20例，正常120例；角度水平172例，倾斜6例；位置上凸12例，下陷31例，正常135例；解剖标志清晰169例，仅能分辨半透明膜及鞍背，漏斗和乳头体等结构模糊8例，完全无法分辨上述结构1例。ETV 过程顺利143例，困难33例，无法完成2例。结论脑积水时第三脑室底解剖形态变异较大，第三脑室底增厚、下陷、倾斜等会增加ETV 的操作难度。内镜下完全无法分辨半透明膜、漏斗及乳头体是ETV 禁忌证。

【关键词】脑积水；脑室造口术；神经内镜；第三脑室；病理状态，解剖学中图分类号：R742.7，R651.11

文献标志码：A

文章编号：1009-122X （2011）07-0299-04

Morphologic feature analysis of the third ventricle floor in patients with hydrocephalus under endoscope

Zhu Guangtong 1,Hu Zhiqiang 1,Huang Hui 1,Guan Feng 1,Dai Bin 1,Wang Shaoheng 1，2,Mao Beibei 1，2,Ren Lening 1，2,Kang Zhuang 1，21.Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China; 2.Harbin Medical University,Harbin,Heilongjiang 150001,China

Abstract:Objective To explore the morphologic features of the third ventricle floor in patients with hydrocephalus,and evaluate their influence on the operative procedure of endoscopic third ventriculostomy (ETV).Methods The morphological features of the third ventri1e floor in 178patients with hydrocephalus were analyzed retrospectively.Their influence on and related techniques in the operative procedure for ETV were summarized.Results The morphology of the third ventri1e floor changed as follows:the width increased in 167cases,decreased in 2and normal in 9.The thickness became thin in 38cases,thick in 20and was normal in 120.The angle was horizontal in 172cases and sloping in 6.The floor raised in 12cases,sagged in 31and normal in 135.The anatomical landmarks were clear in 169cases,only the translucent membrane and dorsum sellae could be distinguished,but indistinguish the infundibular recess and mammillary body in 8and could not any in 1.The process of ETV was smooth in 143cases,difficult in 33and could not be completed in 2.Conclusions There is a greater variation in the anatomic form of the third ventricle floor in patients with hydrocephalus.Some characteristics in the third ventricle floor such as heavy thickness,sinking and incline can increase the procedure difficulty of ETV.The contraindications of ETV are the condition under which the infundibular recess,mammillary body and translucent membrane can not be identified at all.Key words:hydrocephalus;ventriculostomy;neuroendoscopes;third ventricle;pathological conditions,anatomical