目的：总结1岁以下非交通性脑积水病儿能成功进行脑室镜第三脑室底造瘘术（ETV）的脑室解剖特征。方法回顾性分析16例1岁以下非交通性脑积水病儿的临床资料，术前均行MRI检查，结合MRI与术中脑室镜下所见的第三脑室的解剖学特征，分析其与手术效果的关系。结果 MRI检查显示院可能影响实施ETV的第三脑室异常解剖特征包括巨大中间块、第三脑室底部倾斜、第三脑室前后径狭窄、桥前池狭窄、第三脑室底部厚度大于2 mm；而术中脑室镜下所见影响ETV的异常解剖特征有室间孔狭窄、前联合肥大、巨大中间块、第三脑室底不透明。如果同时存在桥前池狭窄和第三脑室底部厚度大于2 mm，或巨大中间块和第三脑室前后径狭窄同时出现时，将会使ETV失败的风险大大增加。结论术前MRI评估和术中脑室镜下观察第三脑室解剖学特征对成功实施ETV十分重要。%Objective To summarize the third ventricular anatomical features which could make infant less than 1 year old with noncommunicating hydrocephalus get successful endoscopic third ventriculostomy (ETV). Methods Clinical data of 16 infants less than 1 year old with noncommunicating hydrocephalus were reviewed retrospectively. Based on preoperative MRI information and ventriculoscopic films, the relationships between anatomical features of the third ventricle and surgical outcomes were analyzed. Results According to the MRI examination, the abnormal anatomical features of the third ventricle that might interfere with ETV included huge massa intermedia, sloping of the third ventricular floor, narrow anteroposterior diameter of the third ventricle, narrow prepontine cistern and third ventricle floor thickness more than 2 mm. While the abnormal endoscopic findings included narrow foramen of Monro, hypertrophy of the anterior commissure, huge massa intermedia and opaque third ventricular floor. The risk of ETV failure would increase if there were both narrow prepontine cistern and third ventricle thickness more than 2 mm, or both huge massa intermedia and narrow anteroposterior diameter of the third ventricle. Conclusion The anatomical features of the third ventricle gotten in preoperative MRI evaluation and intraoperative endoscopic findings are very important for successful performance of ETV.
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