Purpose

Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures.

Methods

We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed.

Results

28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively.

Conclusion

Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.

中文翻译：

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1 岁以下婴儿脑室内神经内窥镜手术的打开和关闭：机构技术、病例系列和文献回顾。

目的

脑室内神经内窥镜技术，特别是第三脑室造口术，越来越多地用于治疗婴儿脑积水。然而，手术进入心室腔与术后脑脊液 (CSF) 泄漏的风险相关。在这里，我们描述了一种结构化的、多层的伤口打开和闭合方法，旨在最大限度地提高自然组织屏障以防止脑脊液渗漏。我们介绍了一系列接受这种技术的患者，随后回顾了有关儿科脑室内神经内窥镜手术中打开和闭合技术的文献。

方法

我们对 5 年内在单一机构接受脑室内神经内窥镜手术的 1 岁以下患者进行了回顾性病例系列分析。从机构手术数据库中确定患者，随后审查手术记录和临床记录。

结果

28 名患者符合本研究的纳入标准。手术的平均年龄为 9 周。27 名患者接受了内镜下第三脑室造口术，1 名患者接受了内镜下间隔造口术，所有患者均接受了我们的结构化、多层开合技术。随访时间为 4 个月至 5 年。没有发生术后脑脊液漏、感染或伤口破裂的病例。12 名患者在最后一次随访中保持无分流术，其余 16 名患者在术后平均 24 天因进行性脑积水需要置入分流术。

结论

文献中报道了各种旨在防止术后脑脊液泄漏的方法。我们建议，我们的机构技术可能有助于最大限度地降低接受内镜下第三脑室造口术和类似脑室内神经内窥镜手术的婴儿的这种风险。