Hydrocephalus third ventriculostomy fistula

Hydrocephalus is a common disease of the nervous system, and there are many surgical treatment methods. Traditional treatments include craniotomy of the third ventricle stoma and various shunts. The third ventricle stoma of the craniotomy is now less used because of the trauma. In various shunt operations, ventriculo-peritoneal shunt is the most widely used, and common complications include shunt obstruction and infection; pediatric patients need to undergo surgery again because of their long height. The use of neuroendoscopy for the third ventricle ostomy can achieve minimally invasive, direct surgery, to avoid the drawbacks of the above-mentioned surgical procedures, through the stoma to make the cerebrospinal fluid into the normal circulation absorption process. Treating diseases: hydrocephalus Indication 1. Aqueduct stenosis obstructive hydrocephalus. 2. Obstructive hydrocephalus caused by the pineal body area and the posterior cranial fossa. 3. Contraindications to patients with ventricle-peritoneal shunt, such as ascites, abdominal infections, etc. Contraindications 1. Traffic hydrocephalus. 2. The interventricular space and the third ventricle are small in width and are not suitable for endoscopic insertion. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. 5. Prepare the endoscopic surgery equipment. Surgical procedure Incision The scalp incision was made about 1 cm in front of the midline and 1 cm in front of the coronal sinus. The skull was drilled with a 1 cm diameter bone hole. The "ten" of the dura mater is cut so that it can be placed in the endoscope. 2. Enter the lateral ventricle A mirror sheath with a lead core diameter of 3 to 6 mm was inserted into the lateral ventricle, the lead core was pulled out and replaced with an endoscope, and the ipsilateral interventricular space was found by means of a septal vein, a choroid plexus, and a mound vein. 3. Enter the third ventricle The endoscope enters the third ventricle through the interventricular space. When the bottom of the third ventricle is reached, the white papillary body with bilateral white reflections can be seen. The initial segment of the basilar artery and the bilateral posterior cerebral artery can be seen through the thinned ependymal membrane. 4. Stoma The position of the ostomy between the feet is at the midline of the anterior basement of the basilar artery. The thinned eustachian membrane is cut into a small opening, and the stoma is expanded to a diameter of 5 mm by the balloon catheter, so that the third ventricle is connected with the inter-foot pool. lasting. complication 1. The earliest and most serious complication after surgery is intracranial hemorrhage. A common cause is that hemostasis is not complete during surgery. Patients with concurrent intracranial hemorrhage, or delayed waking after surgery, or apathy, lethargy, headache, vomiting, seizures or re-coma after waking. Therefore, there is no special reason after surgery for a long time, not awake or consciousness is gradually worsened, and signs of increased intracranial pressure such as slow pulse, elevated blood pressure, or new neurological symptoms should be paid attention to, should be highly alert to the skull The possibility of internal bleeding. CT examination should be performed in time when conditions are met, and the hematoma should be removed immediately after diagnosis. The earlier the surgery, the better the consequences. 2. Oculomotor paralysis, memory impairment, ataxia and lethargy, etc., are mostly temporary.