| Co-Investigator(Kenkyū-buntansha) |
TOSHIAKI Abe Jikei University, Research Assistant, 医学部, 教授 (30112808)
NOBUYOSHI Kaito Jikei University, Research Assistant, 医学部, 助手 (30224330)
TATSUHIRO Joki Jikei University, Professor, 医学部, 助手 (30226378)
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| Research Abstract |
The characteristics of the cerebrospmal fluid (XSF) dynamics in the individual specific pathophysiologies were delineated by cardiac-gated cine-mode magnetic resonance imaging (MRI) before and after the endoscopic procedure. Neuroendoscopic surgery was used tp treat patients with various forms of hydrocephalus with specific pathophysiology, including long-standing overt ventriculomegaly in adulthood (LOVA), isolated unilateral hydrocephalus (IUH), isolated IV ventricle (IFV), disproportionately large IV ventricle (DLFV), isolated rhombencephahc ventricle (IRV) isolated quarto-ventriculomegaly (IQV), dorsal sac in holoprosencephaly (DS) and loculated ventricle (LV).These procedures included III ventnculostomy, aqueductal plasty by both rostral and caudal approaches, foraminal plasty in the foramen of Monro/foramen of Magendie, septostomy, IV ventnculostomy, fenestration of septation in the loculated ventricle fenestration of arachnoid cyst or cystic tumor obstructing a ventricle with or
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without tumor removal and dorsal sac ventnculostomy The postoperative changes of ventriculomegaly were complicated, reflecting the differences in the brain parenchymal compliance and postoperatively corrected CSF flow dynamijcs in the major CSF pathway. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except m selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful m patients with primary aqueductal stenosis even in those with a history of hemorrhage or CSF infection. It was found that the operative goal creating the state of arrested hydrocephalus, could be obtained by opening the ventricular isolation but not always by achieving communication with the cisterns especially in infants. This may be due to the immaturity of the subarachnoid CSF dynamics in the infants. Pre-and postoperative cine-mode MRI is a very useful ijiethod of estimating the CSF dynamics in the major CSF pathway. Less
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