| Objective The pathogenesis of hydrocephalus is various, genetic factors, infection and cancer, is an important cause of hydrocephalus. The clinical performance for most patients with malabsorption of cerebrospinal fluid circulation is blocked. Hydrocephalus in clinical on can according to the pathological traffic and obstruction of brain water two types. The type of hydrocephalus is a common clinical communicating hydrocephalus is by malabsorption of cerebrospinal fluid circulation and even blocked pathway leading to hydrocephalus. Clinical for hydrocephalus by cerebrospinal fluid circulation pathway is even malabsorption due to blocked hydrocephalus. The main features of obstructive hydrocephalus is the lesions in the ventricle and hydrocephalus around. Once formed, will block the cerebrospinal fluid pathway, clinical manifestations of ventricular dilatation, and this change is irreversible. With the increase of intracranial pressure compression development condition, leading to blocked blood circulation, and even cause brain atrophy. The clinical manifestations of patients with hydrocephalus is varied, such as headache and dizziness, nausea and vomiting phenomenon, with varying degrees of limb weakness, decreased visual acuity, slurred speech, severe disturbance of consciousness. The diagnosis method of clinical diagnosis and imaging mainly includes two kinds of typical symptoms of diagnosis, the diagnostic imaging is the most accurate means of diagnosis. But at present the clinical CT(Computed Tomography) examination only provides clinicians with a hydrocephalus ventricular enlargement of radiographic images, the image is not clear for clinicians patients with communicating hydrocephalus or obstructive hydrocephalus. 3D-space is a new type of magnetic resonance technology, mainly by 0.7mm ultra-thin layer scanning diagnosis for clinicians to provide anatomical image, the image has a strong contrast, can be in interventricular foramen, cerebral aqueduct, cisterns and other parts of the diaphragm clearly displayed, help clinical diagnosis for patients with communicating hydrocephalus or obstructive hydrocephalus, and then determine whether the patients received ETV treatment. At the same time to image 3D-SPACE MRI scans obtained based on 3D reconstruction of virtual endoscopic images, in the clearest and most intuitive way to show the cerebral ventricle, judgment chamber orifice obstruction and midbrain aqueduct. Hydrocephalus is a clinical common disease in clinical department of Neurosurgery, there are two kinds of treatment methods, they are endoscopic third ventriculostomy and ventriculoperitoneal shunt. Endoscopic third ventricle floor made fistula is under neuroendoscope under direct vision, subarachnoid space and the third ventricle using micro forceps or balloon open, followed by the establishment of the operation mode of the new pathway of CSF circulation. Ventriculo peritoneal shunt is by a group with one-way valve of the shunt device into patients in the brain indoor cerebrospinal fluid shunt intraperitoneal and absorption of the operation. Postoperative occurrence of ventricular end of the shunt tube puncture lost, intraventricular hemorrhage all kinds of abdominal complications, pneumothorax, shunt system obstruction or excessive drainage and other complications. In recent years, with the general improvement in surgical techniques and progress of surgical instruments, endoscopic third Compared to the floor of the third ventricle made fistula showed obvious advantages in the treatment of hydrocephalus with ventriculo peritoneal shunt, operation is more simple, with higher operation safety and validity of the postoperative patients with improved significantly. In this study, mainly correlation of hydrocephalus of imaging diagnosis and surgical treatment methods to carry on the research analysis, and according to the diagnostic imaging and virtual endoscopy images of patients for individualized treatment to compare the endoscopic third ventriculostomy and ventriculo peritoneal shunt for hydrocephalus clinical curative effect, experience to provide reference for the means of diagnosis and surgical treatment of clinical hydrocephalus choice.Methods 1. 3D-SPACE scan of 60 cases of secondary hydrocephalus patients. After scanning the DICOM data application 3D-Slicer software for 3D reconstruction of virtual colonoscopy, according to the results of comprehensive judgement, and choose a suitable method of surgical treatment, the correlation and clinical value of the treatment were evaluated according to the information provided by 3D-SPACE sequence and virtual endoscopy. 2. According to the 3D-SPACE image and the virtual endoscope, the surgical procedures were selected to treat the patients.Results 1. In this group of patients according to preoperative imaging, intraoperative nerve endoscope examination and postoperative pathologic results, 60 cases of hydrocephalus patients, 12 cases for communicating hydrocephalus, 48 cases of obstructive hydrocephalus, the latter including 19 cases of midbrain aqueduct obstruction, quadrigeminal body region in 17 cases, posterior of the third ventricle, pineal region tumors, 2 cases of pontine cistern cyst, 4 cases of cysticercosis, 3 cases of Dandy Walker syndrome, 2 cases of intraventricular cysts, 1 cases of ventricular on the right side of the hole atresia. 2. This group of cases in MRI contrast to identify the properties of hydrocephalus: 3D-SPACE diagnosis results show 48 cases of patients with obstructive hydrocephalus, 12 patients for communicating hydrocephalus. Conventional T2 diagnosis results show 37 patients with obstructive hydrocephalus, 23 patients for communicating hydrocephalus. Among them 2 patients by conventional T2 diagnosis for obstructive hydrocephalus, but diagnosed by 3D-SPACE communicating hydrocephalus, 13 patients by conventional T2 diagnosis for communicating hydrocephalus, but the 3D-SPACE diagnosis of obstructive hydrocephalus, which 45(35+10) patients diagnosis diagnosis in two ways results, which 15(2+13) cases with inconsistent results for two kinds of diagnostic methods. The Pearson chi square test results show that the correction chi square =15.44, p < 0.05, the difference has statistical significance. 3. This group of cases confirmed by ventriculoscope for 48 cases of obstructive hydrocephalus, for the MRI can directly show the site of obstruction of contrast: diagnostic T2 showed 35 patients showed obstruction, 3D-SPACE diagnosis showed 47 patients showed the site of obstruction, 3D-SPACE diagnosis of obstructive hydrocephalus sensitivity was 97.9%(47/48). Conventional magnetic resonance imaging techniques in the diagnosis of obstruction of brain water sensitivity was 72.9%(35/48), was significantly lower than that of 3D-SPACE sensitivity, the difference is statistically significant(p < 0.05). 4. T2 MRI provided the full extent of the diagnostic information in 54 patients of grade 1 and 6 cases of patients with grade 0, full degree 90.0%.3D-SPACE which provide the full extent of the diagnostic information in 58 patients of grade 1, 2 cases of patients with grade 0, full degree 96.6%.3D-SPACE the provide diagnostic information to the full extent was superior to MRI T2, the difference was statistically significant(p < 0.05). 5. T2 MRI diagnosis of coverage and signal to noise ratio(46.9±17.2) mm and(15.7±3.5)d B, 3D-SPACE diagnostic coverage and signal to noise ratio( 114.7 ±22.4) mm and(22.7±14.7) d B.3D-SPACE diagnosis of coverage range and signal to noise ratio was significantly better than that of MRI T2, the difference is of statistical significance(p < 0.05). 6. All of the 60 patients in the 3D-SPACE on the basis of successful 3D reconstruction and virtual endoscopy, according to the 3D-SPACE images and 3D virtual endoscopy images were not abdominal surgery history on patients with individualized treatment of.12 patients with hydrocephalus patients with endoscope assisted ventriculoperitoneal shunt. 48 cases of obstruction of brain with hydronephrosis in 19 cases of patients because of the midbrain aqueduct obstruction by ventriculostomy with endoscopic third ventriculostomy; quadrigeminal body region in 17 cases, posterior of the third ventricle and pineal region tumor patients by endoscopic third ventriculostomy substrate fistula combined with tumor biopsy; 2 cases of pontine cistern cyst patients first underwent neuroendoscope assisted coagulation cyst capsule the shrinkage after resection of cyst or fistula of partial cyst; 4 cases of lateral ventricle, three ventricle cysticercosis patients with cysticercosis resection; 3 cases of patients with Dandy-Walker syndrome The neuroendoscope assisted the floor of the third ventricle made fistula combined with nerve endoscope assisted the fourth ventricle center hole and a side hole forming operation. 2 cases of lateral ventricle cysts in patients with endoscope assisted cyst ventricle fistulization; 1 case room on the right side of the hole atresia patients using the endoscope assisted chamber hole unclogging of 48 cases of obstruction of brain hydrops treated by ventriculostomy with neuroendoscope assisted the third ventricle of a total of 39 cases. 7. 12 cases patiens with nerve endoscope assisted ventriculo- peritoneal shunt for treatment of patients with effective rate was 83.3%, 39 cases with neuroendoscope assisted the floor of the third ventricle made fistula patients were treated with the effective rate was 89.6% and the difference was statistically significant(p < 0.05). 8. 12 cases with nerve endoscope assisted ventriculo- peritoneal shunt for the treatment of patients with complications occurrence rate was 25.0%, 1(8.3%) cases of shunt tube blockage, 2(16.7%) patients with fever of 39 cases with neuroendoscope assisted the floor of the third ventricle made fistula surgery in the treatment of patients with complications occurrence rate was 15.4%, 1(2.6%) cases of fistula mouth blockage and adhesion, 1(2.6%) cases of hemorrhage, 1(2.6%) cases of infection, 1(2.6%) cases of fever, 2(5.1%) cases of subcutaneous effusion. The difference is statistically significant(p < 0.05).Conclusion 1. Compared with the conventional magnetic resonance imaging, 3D-SPACE and virtual endoscopy technique can provide more and more obvious anatomy of hydrocephalus patients has a higher value in the diagnosis, the surgical treatment of choice also has the very big help.2. The neuroendoscope assisted the floor of the third ventricle made fistula compared with nerve endoscope assisted ventriculo peritoneal shunt in the treatment of cerebral water, has better clinical efficacy and postoperative complications is low. |
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