第38回日本小児神経外科学会
The 38th Annual Meeting of the Japanese Society for Pediatric Neurosurgery

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第2日目、6月5日(土)A 会場(3階 メインホール)9:30〜10:00

特別講演 2: Mark G. Luciano

座長: 伊達 勲

SL2

Neuroendoscopy in hydrocephalus: the relative roles of the shunt and the scope.

Mark G. Luciano

Section of Pediatric and Congenital Neurosurgery, CSF Physiology Laboratory, Aging Brain Clinic

In the last 2-3 decades advances in neuroendoscope technology have allowed acceptance of the endoscopic third ventriculostomy (ETV) in obstructive hydrocephalus. While ETV efficacy appears established, the relative role of ETV verses shunting remains unclear in specific patients and hydrocephalus types. The frequency of endoscopic treatment varies greatly between institutions but usually remains less than 25-30% of cases. As a result of persistent occurrence of shunting complications there has been a great deal attention and hope in expanding the use of the endoscope beyond ETV and obstructive hydrocephalus. Clearly, the endoscopy has been useful in multiple forms of obstructive hydrocephalus in the presence of loculations and cysts where endoscopy shows definite advantage over complex shunting. Endoscopic procedures extend beyond ETV and include choroid plexus coagulation, aqueductoplasty or cyst fenestration or tumor excision and shunt hardware manipulation. More controversial is the use of endoscopy in communicating hydrocephalus such as in NPH, in post-infectious (especially TB) hydrocephalus and as a first attempt in all infant hydrocephalus. Application of endoscopy in these situations could potentially result in a major shift in the relative use endoscopy verses shunting. However, just as with the use of ETV in obstructive hydrocephalus, analysis of relative utility awaits clinical studies that weigh and directly compare complication rates over time along with the durability and degree of improvement.

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