Neurological Surgery 脳神経外科35巻6号

2007年06月発行

総説

内視鏡的第3脳室底開窓術

著者： 宮嶋雅一¹

所属機関： ¹順天堂大学医学部脳神経外科

ページ範囲：P.543 - P.555

はじめに

　脳室短絡術が安定した成績をもって受け入れられる以前には，非交通性水頭症に対する標準的な手術法は第3脳室底開窓術であった．

　1922年Dandyは前頭開頭にて終板を開窓することにより，第3脳室と視交叉槽に交通をつけた²⁴⁾．この直達手術は侵襲が大きいため，その後側頭下法にて第3脳室底を開窓することにより第3脳室脚間槽に交通をつける方法に改変した^25,26)．1945年には，52例の直達開窓術による手術死亡率12％，外科的停止50％と報告した．1923年，初めて内視鏡下に第3脳室底開窓術を行ったのはMixterであった．彼は生後9カ月の非交通性水頭症の乳児に，尿道鏡を用いて第3脳室底を開窓した⁷³⁾．当時は他の外科手術と同様に，第3脳室底開窓術による合併症の頻度や死亡率が高く，また，内視鏡装置の技術的な問題により，第3脳室底開窓術は広く普及しなかった．1947年，McNickleは経皮的第3脳室底開窓術を導入し，第3脳室底開窓術による死亡率は数％以下まで低下した⁷⁰⁾．しかし，1950年代初頭に脳室心房短絡術が開発・導入され，水頭症の治療成績が格段に向上し，第3脳室底開窓術への関心は薄れていった．その後短絡術後の長期治療成績が報告されるにつれて，合併症（機能不全，感染，over drainageなど）が比較的多いことが明らかとなった．

　1975年Griffith，1978年Vriesが，近代化された軟性鏡を用いた第3脳室底開窓術を報告した^42,108)．1990年Jonesらの24例での治癒率50％の報告，その後35例の集積での治癒・改善率80％，非致死的合併症（片麻痺，感染など）8％の卓越した報告があり，同時期，他の外科領域での内視鏡下手術の発達と低侵襲手術の社会的要求に触発され，第3脳室底開窓術は再び脚光を浴びるようになった⁵⁶⁾．

　本邦では1994年に日本神経内視鏡研究会が発足し，2002年学会に昇格した．同年の診療報酬改正に伴い内視鏡的第3脳室底開窓術は保険診療の適応を受け，非交通性水頭症の標準的手術法と認知されるに至った．しかし，手術症例数が増加するにつれ様々な問題点が明らかになり，昨年度より神経内視鏡の技術認定制度が発足した．この時期に内視鏡的第3脳室底開窓術の問題点を整理し検討することは，時宣を得たことと思われる．本項では内視鏡的第3脳室底開窓術の適応とその問題点，ならびに術後経過とその成績について述べる．

参考文献

1）Amano T, Inamura T, Nakamizo A, Inoha S, Wu GM, Ikezaki K：Case management of hydrocephalus associated with the progression of childhood brain stem gliomas.Child's Nerv Syst 18：599-604, 2002

2）Ambesh SP, Kumar R：Neuroendoscopic procedures：anesthetic considerations for a growing trend：a review. J Neurosurg Anesthesiol 12：262-270, 2000

3）Anandh B, Madhusudan Reddy KR, Mohanty A, Umamaheswara Rao GS, Chandramouli BA：Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy. Minim Invasive Neurosurg 45：154-157, 2002

4）Baskin JJ, Manwaring KH, Rekate HI：Ventricular shunt removal：the ultimate treatment of the slit ventriclesyndrome. J Neurosurg 88：478-484, 1998

5）Beems T, Grotenhuis JA：Is the success rate of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy in young children. Child's Nerv Syst 18：605-608, 2002

6）Bellotti A, Rapana A, Iaccarino C, Schonauer：Intracranial pressure monitoring after endoscopic third ventriculostomy：an effective method to manage the ‘adaptaion period’. Clin Neurol Neurosurg 103：223-227, 2001

7）Bognar L, Borgulya G, Benke T, Madarassy G：Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Child's Nerv Syst 19：332-336, 2003

8）Brockmeyer D, Abtin K, Carey L, Walker M：Endoscopic third ventriculostomy：an outcome analysis. Pediatr Neurosurg 28：236-240, 1998

9）Butler WE, Khan SA：The application of controlled intracranial hypertension in slit ventricle syndrome patients with obstructive hydrocephalus and shunt malfunction. Pediatr Neurosurg 35：305-310, 2001

10）Buxton N, Ho KJ, Macarthur D, Vloeberghs M, Punt J, Robertson I：Neuroendoscopic third ventriculostomy for hydrocephalus in adults：Report of a single unit's experience with 63 cases. Surg Neurol 55：74-78, 2001

11）Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M：Neuroendoscopeic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29：73-76, 1998

12）Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M：Neuroendoscopy in the premature population. Child's Nerv Syst 14：649-652, 1998

13）Buxton N, Jaspan T, Punt J：Treatment of Chiari malformation, syringomyelia and hydrocephalus by neuroendoscopic third ventriculostomy. Minim Invasive Neurosurg 45：231-234, 2002

14）Carpentier A, Brunelle F, Philippon J, Clemenceau S：Obstruction of Magendie's and Luschka's foramens. Cine MRI, aetiology and pathogenesis. Acta Neurochir (Wien) 143：517-522, 1999

15）Cartmill M, Vloeberghs M：The fate of the cerebrospinal fluid after neuroendoscopic third ventriculostomy. Child's Nerv Syst 16：879-881, 2000

16）Choi JU, Kim DS, Kim SH：Endoscopic surgery for obstructive hydrocephalus. Yonsei Med J 40：600-607, 1999

17）Cinalli G, Salazar C, Yada JZ, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D, Sainte-Rose C：The role of third ventriculostomy in the management of shunt malfunction. Neurosurgery 43：1323-1329, 1998

18）Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D：Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90：448-454, 1999

19）Cinalli G, Sainte-Rose C, Simon I, Lot G, Sgouros S：Sylvian aqueduct syndrome and global dorsal midbrain dysfunction associated with shunt malfunction. J Neurosurg 90：227-236, 1999

20）Cinalli G：Alternatives to shunting. Child's Nerv Syst 15：718-731, 1999

21）Cinalli G, Ruggiero C, Aliberti F, Maggi G：ICP monitoring following endoscopic third ventriculostomy in children. Child's Nerv Syst 18：548, 2002

22）Cipri S, Cafarelli F：Successful endoscopic third ventriculostomy in noncommunicating thoracic syringomyelia. Acta Neurochir (Wien) 144：93-95, 2002

23）Connor SEJ, O’Gorman R, Summers P, Simmons A, Moore EM, Chandler C, Jarosz JM：SPAMM, cine phase-contrast imaging and fast spin-echo T2-weighted imaging in the study of intracranial cerebrospinal fluid (CSF) flow. Clin Radiol 56：763-772, 2001

24）Dandy WE：An operative approach for hydrocephalus. Bull Johns Hopkins Hosp 33：189-190, 1922

25）Dandy WE：Surgery of the brain. In：Lewis’ practice of surgery, vol 12. Prior, Hagerstown, pp671-688, 1932

26）Dandy WE：Diagnosis and treatment of strictures of the aqueduct of Sylvius (causing hydrocephalus). Arch Surg 51：1-14, 1945

27）Decq P, Le Guerinel C, Sol JC, Brugieres P, Djindjian M, Nguyen JP：Chiari I malformation：a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. J Neurosurg 95：783-790, 2000

28）Doczi T, Veto F, Horvath Z：Clinical analysis of 89 consecutive 3rd ventriculostomies (abstract). Minim Invasive Neurosurg 41：112, 1998

29）Elbabaa SK, Steinnetz M, Ross J, Moon D, Luciano M：Endoscopic third ventriculostomy for obstructive hydrocephalus in the pediatric population：evaluation of outcome. Eur J Pediatr Surg 11 (Suppl I)：552-554, 2001

30）Fabregas N, Lopez A, Valero R, Carrero E, Caral L, Ferrer E：Anesthetic management of surgical neuroendoscopies：usefulness of monitoring the pressure inside the neuroendoscope. J Neurosurg Anesthesiol 12：21-28, 2000

31）Fabregas N, Valero R, Carrero E, Tercero J, Caral L, Zavala E, Ferrer E：Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracranial circulatory insufficiency. J Neurosurg Anesthesiol 13：152-157, 2001

32）Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumia J：Neuroendoscopic management of pineal region tumors. Acta Neurochir 139：12-21,1997

33）Figaji AA, Fieggen AG, Peter JC：Endoscopic third ventriculostomy in tuberculous meningitis. Chid's Nerv Syst 19：217-225, 2003

34）Frim DM, Goumnerova L：Telemetric intraventricular pressure measurement after third ventriculostomy in a patient with noncommunicating hydrocephalus. Neurosurgery 41：1425-1428, 1997

35）Fritsh MJ, Mehdorn M：Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age. Pediatr Neurosurg 36：183-188, 2002

36）Fukuhara T, Vorster SJ, Ruggieri P, Luciano MG：Third ventriculostomy patency：comparison of findings at cine phase-contrast MR imaging and at direct exploration. AJNR Am J Neuroradiol 20：1560-1566, 1999

37）Fukuhara T, Vorster SJ, Luciano MG：Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46：1100-1111, 2000

38）Fukuhara T, Luciano MG：Clinival features of late-onset idiopathic aqueductal stenosis. Surg Neurol 55：132-137, 2001

39）Fukuhara T, Luciano MG, Kowalski RJ：Clinical features of third ventriculostomy failures classified by fenestration patency. Surg Neurol 58：102-110, 2002

40）Gorayeb RP, Cavalherio S, Zymberg ST：Endoscopic third ventriculostomy in children younger than 1 year of age. J Neurosurg 100 (5 Suppl Pediatrics)：427-429, 2004

41）Goumnerova LC, Frim D：Treatment of hydrocephalus with third ventriculostomy：outcome and CSF flow paterns. Pediatr Neurosurg 27：149-152, 1997

42）Griffith HB：Technique of fontanelle and persutural ventriculoscopy and endoscopic ventricular surgery in infants. Child's Brain 1：359-363, 1975

43）Grunert P, Charalampaki P, Hopf N, Filippi R：The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg 46：16-21, 2003

44）Guiot G：Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir 28：275-289, 1973

45）Hader WJ, Drake J, Cochrane D, Sparrow O, Johnson ES, Kestle J：Death after late failure of third ventriculostomy in children. J Neurosurg 97：211-215, 2002

46）Hashish H, Guenot M, Mertens P, Sindou M：Hydrocephalie chronique de l’ouverture mediane du quatrieme ventricule (foramen de Magendie). Neurochirurgie 45：232-236, 1999

47）Haw C, Steinbok P：Ventriculoscope tract recurrence after endoscopic biopsy of pineal germinoma. Pediatr Neurosurg 34：215-217, 2001

48）Hayashi N, Hamada H, Hirashima Y, Kurimoto M, Takaku A, Endo S：Clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus. Minim Invasive Neurosurg 43：181-186, 2000

49）Hirsch JF, Hirsch E, Saint-Rose C, Renier D, Pierre-Kahn A：Stenosis of the aqueduct of Sylvius. Etiology and treatment. J Neurosurg Sci 30：29-36, 1986

50）Hoffman HJ, Harwood-Nash D, Gilday DL, Craven MA：Percutaneous third ventriculostomy in the management of noncommunicating hydrocephalus. Neurosurgery 7：313-321, 1980

51）Hopf NJ, Grunert P, Fries G, Resch KDM, Perneczky A：Endoscopic third ventriculostomy：outcome analysis of 100 consecutive procedures. Neurosurgery 44：795-804, 1999

52）Inamura T, Morioka T, Nishio S, Ikezaki K, Nonaka H, Yoshiura T：Diverticular enlargement of the foramena of Luschka and congenital hydrocephalus. Child's Nerv Syst 18：652-655, 2002

53）Jack CR Jr, Kelly PJ：Stereotactic third ventriculostomy：assessment of patency with MR imaging. AJNR Am J Neuroradiol 10：515-522, 1989

54）Javadpour M, Mallucci C, Brodbelt A, Golash A, May P：The impact of endoscopic third ventriculostomy on the management of newly diagnosed hydrocephalus in infants. Pediatr Neurosurg 35：131-135, 2001

55）Jellinger G：Anatomopathology of nontumoral aqueductal stenosis. J Neurosurg Sci 30：1-16, 1986

56）Jones RF, Stening WA, Brydon M. Endoscopic third ventriculostomy. Neurosurgery 26：86-91, 1990

57）Jones RFC, Kwok BCT, Stening WA：The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37：28-36, 1994

58）上川秀士，桑村圭一，藤田敦史，玉木紀彦：圧可変式バルブシャントシステム(Medos Programmable Hakim Valve)と脳室ファイバースコープによるSlit-like Ventricleの治療．No Shinkei Geka 26：349-356, 1998

59）Karachi C, Le Guerinel C, Brugieres P, Melon E, Decq P：Hydrocephalus due to idiopathic stenosis of the foramina of Magendie and Luschka. Report of three cases. J Neurosurg 98：897-902, 2003

60）Kehler U, Gliemroth J, Knopp U, Arnold H：The role of third ventriculostomy in previously shunted hydrocephalus. In：Hellwig D, Bauer B (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin, pp77-80, 1998

61）Kehler U, Gliemroth J：Extraventricular intracisternal obstructive hydrocephalus －a hypothesis to explain successful 3 rd ventriculostomy in communicating hydrocephalus. Pediatr Neurosurg 38：98-101, 2003

62）Kelly PJ：Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus. J Neurosurg 75：865-873, 1991

63）Koch D, Grunert P, Filippi R, Hopf N：Re-ventriculostomy for treatment of obstructive hydrocephalus in cases of stoma dysfunction. Minim Invasive Neurosurg 45：158-163, 2002

64）Kulkarny AV, Drake JM, Armstrong DC, Dirks PB：Imaging correlates of successful endoscopic third ventriculostomy. J Neurosurg 92：915-919, 2000

65）Kwiek SJ, Mandera M, Baowski P, Luszawski J, Duda I, Wolwender A, Zymon-Zagorska A, Grzybowska K：Endoscopic third ventriculostomy for hydrocephalus：early and late efficacy in relation to aetiology. Acta Neurochir (Wien) 145：181-184, 2003

66）Lev S, Bhadelia RA, Estin D, Heilman CB, Wolpert SM：Functional analysis of third ventriculostomy patency with phase-contrast MRI velocity measurements. Neuroradiology 39：175-179, 1997

67）Macarthur DC, Buxton N, Vloeberghs M, Punt J：The effectiveness of neuroendoscopic interventions in children with brain tumours. Child's Nerv Syst 17：589-594, 2001

68）Mandat T, Roszkowski M, Barszcz S, Podgorski JK, Jurkiewicz E：Neuroendoscopy in the treatment of third ventricular hydrocephalus accompanying tumors of the posterior part of the third ventricle in children. Neurol Neurochir Pol 36：711-722, 2002

69）Matson DD：Neurosurgery of infancy and childhood, 2nd ed. Charles C Thomas, Springfield, Illinois, 1969

70）McNickle HF：The surgical treatment of hydrocephalus. A simple method of performing third ventriculostomy. Br J Surg 34：302-307, 1947

71）Metellus P, Dufour H, Levrier O, Grisoli F：Endoscopic third ventriculostomy for treatment of noncommunicating syringomyelia associated with a Chairi I malformation and hydrocephalus：case report and pathophysiological considerations. Neurosurgery 51：500-503, 2002

72）Missir O, Dormont D, Pierot L：MR visualization of CSF flow through a ventriculocisternostomy. Neuroradiology 31：93-94, 1989

73）Mixter WJ：Ventriculoscopy and puncture of the floor of the third ventricle. Preliminary report of a case. Boston Med Surg J 188：277-278, 1923

74）Mizoguchi M, Inamura T, Hikita T, Cheng CL, Ohgami S：Neuroendoscopic biopsy of tectal glioma：a case report. Minim Invasive Neurosurg 43：53-55, 2000

75）Mohanty A, Anandh B, Sastry Kollury VR, Praharaj SS：Neuroendoscopic third ventriculostomy in the management of fourth ventricular outlet obstruction. Minim Invasive Neurosurg 42：18-21,1999

76）Mohanty A, Vasudev MK, Sampath S, Radhesh S, Sastry Kolluri VR：Faild endoscopic third ventriculostomy in children：management options. Pediatr Neurosurg 37：304-309, 2002

77）Mohanty A, Biswas A, Satish S, Praharaj SS, Sastry K：Treatment options for Dandy-Walker malformation. J Neurosurg 105 (5 Suppl Pediatrics)：348-356, 2006

78）Nishihara T, Hara T, Suzuki I, Kirino T, Yamakawa K：Third ventriculostomy for symptomatic syringomyelia using flexible endoscope：case report. Minim Invasive Neurosurg 39：130-132, 1996

79）Nishiyama K, Mori H, Tanaka R：Changes in cerebrospinal fluid hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicating hydrocephalus. J Neurosurg 98：1027-1031, 2003

80）Ogata H, Oka K, Mitsudome A：Hydrocephalus due to acute aqueductal stenosis following mumps infection：report of a case and review of the literature. Brain Dev 14：417-419,1992

81）Oi S, Shibata M, Tominaga J, Honda Y, Shinoda M, Takei F, Tsugane R, Matsuzawa K, Sato O：Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors：a prospective study. J Neurosurg 93：245-253, 2000

82）Oi S, Kamio M, Joki T, Abe T：Neuroendoscopic anatomy and surgery in pineal region tumors：role of neuroendoscopic procedure in the ‘minimally-invasive preferential’ management. J Neurooncol 54：277-286, 2001

83）Oka K, Go Y, Kin Y, Utsunomiya H, Tomonaga M：The radiographic restoration of the ventricular system after third ventriculostomy. Minim Invasive Neurosurg 38：158-162, 1995

84）Oka K：Neuroendoscopic approach to tectal tumors：a consecutive series. J Neurosurg 91：964-970, 1999

85）Pierre-Kahn A, Reneir D, Bombois B, Askienay S, Moreau R, Hirsch J：La place de la ventriculocisternostomi dans le traitement des hydrocephalies non communicantes de l’enfant. Neurochirurgie 21：557-569, 1975

86）Pople IK, Athanasiou TC, Sandeman DR, Coakham HB：The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours. Br J Neurosurg 15：305-311, 2001

87）Reddy K, Fewer HD, West M, Fewer D：Slit ventricle syndrome with aqueduct stenosis. Third ventriculostomy as definitive treatment. Neurosurgery 23：756-759, 1988

88）Rieger A, Rainov NG, Sanchin L, Schopp G, Burkert W：Ultrasound-guided endoscopic fenestration of the third ventricle in obstructive hydrocephalus. In：Hellwig D, Bauer B (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin, pp81-85, 1998

89）Rieger A, Rainov NG, Brucke M, Marx T, Holz C：Endoscopic third ventriculostomy is the treatment of choice for obstructive hydrocephalus due to pediatric pineal tumors. Minim Invasive Neurosurg 43：83-86, 2000

90）Robinson S, Cohen A：The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 40：360-365, 1997

91）Rohde V, Gilsbach JM：Anomalies and variants of the endoscopic anatomy for third ventriculostomy. Minim Invasive Neurosurg 43：111-117, 2000

92）Sainte-Rose C：Third ventriculostomy. In：Manwaring KH, Crone KR (eds) Neuroendoscopy. Mary Ann Liebert, New York, pp47-62, 1992

93）Sainte-Rose C, Cinalli G, Roux FE, Maixner W, Chumas PD, Mansour M, Carpentier A, Bourgeois M, Zerah M, Pierre-Kahn A, Renier D：Management of hydrocephalus in pediatric patients with posterior fossa tumors：the role of endoscopic third ventriculostomy. J Neurosurg 95：791-797, 2001

94）Scarff JE：Evaluation of treatment of hydrocephalus. Results of third ventriculostomy and endoscopic cauterization of choroids plexus compared with mechanical shunts. Arch Neurol 14：382-391, 1966

95）Schijins OE, Beuls EA：Parinaud's syndrome as a sign of acute obstructive hydrocephalus：recovery after acute ventriculostomy. Ned Tijdschr Geneeskd 46：1136-1140, 2002

96）Schwartz TH, Yoon SS, Cutruzzola FW, Goodman RR：Third ventriculostomy：post-operative ventricular size and outcome. Minim Invasive Neurosurg 39：122-129, 1996

97）Schwartz TH, Ho B, Prestigiacomo CJ, Bruce JN, Feldstein NA, Goodman RR：Ventricular volume following third ventriculostomy. J Neurosurg 91：20-25, 1999

98）Siomin V, Weiner H, Wisoff J, Cinalli G, Pierre-Khan A, Sainte-Rose C, Abbott R, Elran H, Beni-Adani L, Ouaknine G, Constantini S：Repeat endoscopic third ventriculostomy：is it worth trying? Child's Nerv Syst 17：551-555, 2001

99）Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi M, Mallucci C, Abbott R, Wisoff J, Constantini S：Endoscopic third ventriculostomy for patients with cerebrospinal fluid infections and/or hemorrhage. J Neurosurg 97：519-524, 2002

100）Suehiro T, Inamura T, Natori Y, Sasaki M, Fukui M：Successful endoscopic third ventriculostomy for hydrocephalus and syringomyelia associated with fourth ventricular outlet obstruction. J Neurosurg 93：326-329, 2000

101）Teo C, Jones RFC, Stening WA：Neuroendoscopic third ventriculostomy. In：Matsumoto S (ed) Hydrocephalus：pathogenesis and treatment. Springer, New York, pp680-691, 1991

102）Teo C, Jones R：Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25：57-63, 1996

103）Teo C：Third ventriculostomy in the treatment of hydrocephalus：Experience with more than 120 cases. In：Hellwig D, Bauer B (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin, pp73-76, 1998

104）Tisell M, Almstrom O, Stephensen H, Tullberg M, Wikkelso C：How effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary aqueductal stenosis? Neurosurgery 46：104-110; discussion 110-111, 2000

105）Tuli S, Alshail E, Drake JM：Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus. Pediatr Neurosurg 30：11-15, 1999

106）Tyagi A, Chumas P, Ferrie C：Obstructive hydrocephalus following herpes simplex virus type I encephalitis treated by repeated third ventriculostomy. Pediatr Neurosurg 34：244-246, 2001

107）Volpe JJ：Neurology of the newborn, 2nd ed. Philadelphia, Saunders, 1996, pp403-463

108）Vries JK：An endoscopic technique for third ventriculostomy. Surg Neurol 9：165-168, 1978

109）Wellons JC, Tubbs RS, Banks JT, Grabb B, Blount JP, Oakes WJ, Grabb PA：Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery 51：63-67, 2002

110）Wilcock DJ, Jaspan T, Worthington BS, Punt J：Neuro-endoscopic third ventriculostomy：Evaluation with magnetic resonance imaging. Clin Radiol 52：50-54, 1997

111）Zerah M, Garcia-Monaco R, Rodesch G, Terbrugge K, Tardieu M, de Victor D, Lasjaunias P：Hydrodynamics in vein of Galen malformations. Child's Nerv Syst 3：111-117, 1992