Neurological Surgery 脳神経外科47巻1号

2019年01月発行

特別寄稿 脳神経外科コントロバーシー2019

（3）乳児期の水頭症治療（脊髄髄膜瘤合併）—シャント手術 vs. ETV

著者： 西山健一¹

所属機関： ¹新潟県厚生農業協同組合連合会新潟医療センター脳神経センター脳神経外科

ページ範囲：P.27 - P.37

Ⅰ．はじめに
　乳児期水頭症治療の主目的は，脳損傷を可逆的なうちに阻止して，最良の精神運動発達が得られる状態に導くことである．そのために，頭蓋内圧および髄液動態を，できる限り正常な状態に維持する必要がある．従来，髄液シャント手術はその標準治療であり，この目的達成のために各種シャントシステムの開発と手術手技の工夫がなされてきた．そして，20世紀末には神経内視鏡手術が飛躍的に発展し，内視鏡下第三脳室開窓術（endoscopic third ventriculostomy：ETV）が積極的に施行されるようになった．ETVは体内に異物を留置せず頭蓋内髄液短絡を作れるため，乳児の外科治療としては実に魅力的である．実際に患児の両親へ両手術を提示すると，効果がなく再手術となるリスクを承知の上でも，ETVを選択される方は多い．しかしながら，その時われわれには，できる限り明確な理由をもって両手術のいずれかを推奨すべき姿勢が，本来は求められるはずである．
　2017年10月に名古屋市で開催された日本脳神経外科学会第76回学術総会では，両手術の選択について，参加者投票システムを用いてコメンテーターのレビューとともに議論された．同投票結果を踏まえ，本稿では脊髄髄膜瘤に合併する水頭症の乳児期治療について考える．

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