导水管狭窄导致正常压力脑积水的第三脑室底造瘘术

目的 探讨神经内镜下第三脑室底造瘘术治疗导水管狭窄所致正常压力脑积水(normal pressure hydrocephalus，NPH)的有效性。方法对23例年龄12～71岁的自发性脑积水患者通过术前核磁电影成像法检查及腰穿测压评估，在确诊为导水管狭窄所致的正常压力脑积水后采用神经内镜下第三脑室底造瘘术，术后进行腰穿测压评估及疗效随访。结果19例患者术后腰穿压力较术前下降大于30mmH2O；显效17例，有效1例，暂时性有效1例，无效4例。结论神经内镜下的第三脑室底造瘘术治疗导水管狭窄导致的正常压力脑积水是一种安全、有效的手术方法，术前正确评估脑积水状况是手术成功的关键；核磁电影成像对确定导水管狭窄导致的NPH具有明显诊断价值。

The third ventriculostomy with neuroendoscopy for normal pressure hydrocephalus due to the stenosis of aqueduct

Objective To discuss the validity of the third ventriculostomy with neuroendoscopy for normal pressure hydrocephalus due to the stenosis of aqueduct.Methods We had 23 spontaneous hydrocephalus patients whose age were between 12 and 71.They were proved to be normal pressure non-communicating hydrocephalus through pre-operative cine-MRI and CSF pressure assessing in lumbar puncture.Then we got postoperative CSF pressure value and commited follow-up.Results Postoperative CSF pressure decreasing exceeded 30mmH_2O in 19 cases.17 cases showed significant improvement;one had somewhat improvement;one had temporary improvement and four had no improvement.Conclusion The endoscopic third ventriculostomy is an effective operation for the normal pressure hydrocephalus due to the stenosis of aqueduct.Preoperative CSF pressure assessing is the cirtical procedure for the success.Cine-MRI is of great value to confirm the normal pressure hydrocephalus due to the stenosis of aqueduct.