多普勒微血管探头在三脑室底造瘘术中的应用

目的:探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy, ETV)中,应用多普勒微血管探头作超声检查的意义。方法:单纯神经内镜下完成梗阻性脑积水三脑室底造瘘术34例,其中21例应用多普勒微血管探头经内镜通道抵达三脑室底部进行超声探测,监测基底动脉(BA)的走向、血流速度,进行术中实时定位,造瘘前后记录血管的多普勒超声图像。结果:术后21例(61.76%)影像学证实扩大的脑室术后有回缩;半年后症状缓解29例(85.29%),无效5例(14.71%),2例做脑室-腹腔分流术。无手术死亡或残疾。使用探头组造瘘术前后BA的管径、血流速度无变化,无血管损伤并发症。结论:多普勒微血管探头在神经内镜三脑室底造瘘术中应用,可减少血管损伤类并发症的发生,使得内镜插入定位精确、安全。

Application of ultrasonic microvascular Doppler probe in third ventriculostomy

Objective: To evaluate the usefulness of intraoperative microvascular Doppler sonography(MDS) in endoscopic third ventriculostomy(ETV). Methods: Neuroendoscopic third ventriculostomy was performed in 34 obstructive hydrocephalus patients. In 21 cases, Doppler microvascular probes were inserted in the bottom of third ventricle through endoscopic work channels for ultrasonography, such as inspecting velocity and direction of blood flow of basal artery(BA), real-time view and ultrasonic scan image were recorded before and after fenestration. Result: The ventricles of 21 in 34 patients(61.76%) were contracted, it was proved by imaging examination; 29 patients(85.29%) were symptom-free half year after operations; 5 patients(14.71%) had no effect; 2 patients had to take V-P by-pass operation. No changes of BA diameter and blood flow velocity were detected before and after the procedure. Also no vascular complication was found. Conclusion: Doppler microvascular probe can be used in ETV to inspect the important vessels through the endoscopic canal, so the complications of arterial injury could be avoided effectively. MDS during operation can increase security and accuracy of puncturing bottom of third ventricle.