内視鏡下第三脳室底開窓術

Neuroendoscopic Third Ventriculostomy

Point

・閉塞性水頭症に対して，第三脳室底開窓術は有効な手術方法である．

・脳室内操作も重要であるが，脳室穿刺のプランニングや特に小児水頭症では髄液漏を防止する対策も同じように重要である．

　Endoscopy is essential in less invasive surgery and its use has widely expanded in almost all surgical specialties. This procedure has also been adopted for neurosurgery. It is now introduced in skull base surgery, expanded from endoscopic transsphenoidal surgery, to remove pituitary tumors, assisting tumor removal or removing a tumor only with the endoscope; spine surgery; and endoscopic third ventriculostomy（ETV）. ETV is now accepted as a standard technique for treating noncommunicating hydrocephalus. Currently, 1067 neurosurgeons are certified by the Japan Society for Neuroendoscopy, and endoscopic surgery is recognized as a typical treatment option. This article describes the surgical procedure for ETV, a basic procedure for pediatric hydrocephalus. It is important to master intraventricular manipulation using the endoscope. Also, certain tips must be implemented before and after the endoscopic procedure to avoid complications. It is also necessary to emphasize the difference between adult cases, such as high risk of cerebrospinal fluid leakage in child cases. So that every single effort must be done to avoid this leak.