脳室内血腫に対する神経内視鏡的血腫除去術および第3脳室底開窓術

Endoscopic Evacuation of Intraventricular Hematoma and Third Ventriculostomy

I．はじめに

　脳神経外科領域において神経内視鏡を用いた治療は，近年その適応疾患の拡大が進み，種々の報告がなされている．特に，軟性鏡はその先端のfrexibilityにより脳室内での操作性に富み，脳室内病変の治療に有用性が高い．われわれは脳室内穿破を伴う脳内出血による脳室内血腫例に対し，軟性鏡を用いて脳室内の血腫を除去し，さらに第3脳室底を開窓することで閉塞性水頭症に対処し良好な成績を得ている．今回，その手術手技ならびに治療成績に若干の文献的考察を加え報告する．

We described our experience of three cases treated with endoscopic evacuation of intraventricular hema-toma and third ventriculostomy for a tight intraventricular hematoma associated with intracerebral hemor-rhage. A steerable endoscope was introduced into the anterior horn of the lateral ventricle contralaterally to the intracerebral hemorrhage, through a 14 Fr. peel-away sheath. First, the hematoma in the lateral ven-tricle contralateral to the hemorrhage was evacuated by direct aspiration using a syringe connected to the operative channel of the endoscope, and evacuation of the hematoma was subsequently carried on the third ventricle, aqueduct and the fourth ventricle. After the evacuation of the intraventricular hematoma, third ventriculostomy was performed for acute obstructive hydrocephalus. Finally, the procedure was completed with septostomy and evacuation of the hematoma in the lateral ventricle ipsilateral to the hemorrhage. Sufficient evacuation of the hematoma was obtained in all cases and no major complications were encoun-tered. We conclude that for patients with intraventricular hematoma associated with intracerebral hemor-rhage endoscopic evacuation of intraventricular hematoma brings about sufficient removal of hematoma, reduction of hospitalization time and prevention of subsequent hydrocephalus.