侧脑室-腹腔分流术治疗外伤性脑积水62例临床观察

目的 探讨侧脑室-腹腔分流术治疗外伤性脑积水的适应证及术后并发症的处理.方法 对62例外伤性脑积水患者采用侧脑室-腹腔分流术治疗效果分析.结果 侧脑室-腹腔分流术治疗外伤性脑积水62例,90.3%的病人获得了较好疗效,分流装置的阻塞及术后感染是最常见的并发症.结论 侧脑室-腹腔分流术治疗外伤性脑积水疗效显著,术中严格无菌操作,减少手术创伤及采用最佳的置管方式是减少手术并发症,提高手术成功率的关键.     

脑室-腹腔分流术治疗外伤性慢性脑积水64例分析

目的总结脑室-腹腔分流术治疗外伤性慢性脑积水的手术方法、治疗效果和并发症。方法回顾性分析经脑室-腹腔分流术治疗的64例外伤性慢性脑积水患者的临床资料。结果全组患者术后CT或MRI复查示全脑系统或脑室缩小50例,多数神志、语言、智力与肢体运动均有改善,死亡4例。结论采用脑室-腹腔分流术,能明显改善脑积水患者的生活质量。     

外伤性脑积水101例诊治体会

目的 探讨外伤性脑积水的治疗方法与效果。方法 对101例外伤性脑积水的发生时间、临床特点、治疗方法和治疗结果进行回顾性分析。结果 对50例脑室周围无间质性水肿及无意识障碍者分别给予脑室外引流＋终池置管,腰椎穿刺终池置管脑脊液置换，其中7例无效，9例病情加重行脑室-腹腔分流术；13例颅骨缺损合并脑积水视颅内情况行颅骨修补术，或颅内软化灶、囊肿切除＋修补术，11例有效，2例无效；对38例脑室周围有间质性水肿或意识障碍者行脑室-腹腔分流术。47例脑室-腹腔分流术中，36例有效，11例无效。结论 对外伤性脑积水尽早明确诊断，按脑积水形成原因，具体分析，制定个性化治疗方案，可提高患者的生存质量和预后，减少并发症。     

颅脑外伤术后颅骨缺损并发脑积水28例临床诊治体会

颅骨缺损伴外伤性脑积水是颅脑损伤病人术后常见的后遗症及并发症,主要治疗方法是外科手术治疗.脑室-腹腔分流术及颅骨修补术是常用方法.单纯使用一种手术方法及分期手术虽能取得一定的治疗效果,但术后恢复时间长及并发症较多.     

内镜下第三脑室底造瘘术联合脑室-腹腔分流术治疗外伤性脑积水的疗效分析

目的探讨内镜下第三脑室底造瘘术联合脑室-腹腔分流术治疗外伤性脑积水的效果。方法回顾性分析35例外伤性脑积水的临床资料,均采用内镜下第三脑室底造瘘术联合脑室-腹腔分流术治疗。结果 1例术后因颅内感染死亡;其余34例CT检查显示脑室情况改善。术后GCS评分[(12.5±1.9)分]较术前[(8.5±1.5)分]明显增高(P0.05)。34例术后随访4~18个月,2例发生分流管脑室段堵塞,但脑积水及症状未加重。结论内镜下第三脑室底造瘘术和脑室-腹腔分流术治疗外伤性脑积水疗效满意。     

外伤性脑积水脑室-腹腔分流术后并发症与处理

1993年至2002年间我院共收治的73例外伤性脑积水患者,行脑室-腹腔分流术后发生各种并发症18例(30例次).本文针对外伤性脑积水的发生原因、临床特点及治疗方法进行探讨,并就如何预防并发症避免手术失败进行讨论.     

57例外伤性脑积水的诊治体会

目的探讨颅脑损伤后脑积水的发病机制、临床特点、诊断和治疗。方法回顾性分析2009年7月至2013年11月行脑室-腹腔分流术治疗的57例外伤性脑积水的临床资料。结果术后随访3~12个月,根据GOS评估预后:恢复良好35例,中残12例,重残5例,死亡5例。结论脑室-腹腔分流术是治疗外伤性脑积水的有效方法,大多预后良好,早期诊断对脑积水治疗及预后具有重要的意义。     

脑室-腹腔分流术治疗脑积水107例分析

目的探讨脑室-腹腔分流术治疗各种脑积水的效果。方法对107例各种原因脑积水患者行脑室-腹腔分流术的病例结合文献进行回顾性分析。结果术后总有效率95％以上，出现各种并发症者21例，其中以分流管堵塞最多9例，其次为感染4例，出血4例。结论脑室-腹腔分流术治疗脑积水效果较好，重视预防并发症是手术成功的关键。     

脑室-腹腔分流术的并发症及防治

目的探讨脑积水行脑室-腹腔分流术的并发症及防治方法。方法对46例脑积水行脑室-腹腔分流术患者的资料进行回顾性分析。结果 46例患者中10例发生并发症,发生率为21.7%,其中颅内出血7例,分流系统阻塞2例(其中1例为脑室内出血后合并阻塞),感染1例,癫痫1例。结论脑室-腹腔分流术是治疗脑积水的有效方法,但其并发症发生率仍较高,须十分重视其并发症的防治。     

神经内镜下第三脑室底造瘘术治疗非交通性脑积水（附37例分析）

目的总结神经内镜下第三脑室底造瘘术治疗非交通性脑积水的经验。方法对37例非交通性脑积水病人行神经内镜下第三脑室底造瘘术，随访12-36个月。结果35例病人术后症状明显缓解，且无明显并发症，2例无效者改行脑室-腹腔分流术后症状缓解。结论神经内镜下第三脑室底造瘘术治疗非交通性脑积水是一种微创、有效、术后恢复快、并发症少的手术方法。     

慢性外伤性脑积水的外科治疗(附36例报告)

目的探讨慢性外伤性脑积水的外科治疗。方法回顾性分析2009年1月～2011年6月救治的36例慢性外伤性脑积水患者的临床资料。结果术后1周临床症状缓解29例(80.6%),症状缓解不明显7例(19.4%)。术后随访3～30月,按GOS评估预后,恢复良好24例,中残5例,重残3例,植物生存2例,死亡2例。结论慢性外伤性脑积水首选脑室-腹腔分流手术,正常压力脑积水分流前应先做脑脊液释放试验,合并颅骨缺损的患者可同时行修补手术;室间孔的位置测量对于置管有指导作用。     

Development of obstructive hydrocephalus with lumboperitoneal shunting following subarachnoid hemorrhage.

Hydrocephalus is a frequent complication of subarachnoid hemorrhage (SAH). The optimum method of treating hydrocephalus in this setting has not been determined. We review our experience with patients developing communicating hydrocephalus secondary to SAH and subsequently treated with lumboperitoneal (LP) shunts. Following hospitalization for the treatment of SAH, patients who developed clinical symptoms and radiologic signs of hydrocephalus were treated with (ventriculoperitoneal) VP or LP shunting. Eighteen patients received an LP shunt, of which seven (28%) developed a non-communicating or obstructive hydrocephalus. These seven patients underwent replacement with a VP shunt and have not had further complications. In the setting of post-SAH communicating hydrocephalus, obstructive hydrocephalus may develop after LP shunt placement. Patients who develop this complication and have their LP shunts converted to VP shunts have a favorable prognosis.     

Complete migration of ventriculoperitoneal shunt into the ventricle

Proximal migration of ventriculoperitoneal (VP) shunt is extremely rare. A medium pressure VP shunt was inserted in a 10-month-old infant suffering from severe hydrocephalus. One month later, complete migration of the shunt into the lateral ventricle was encountered. Possible causative mechanisms and the literature on this subject are briefly discussed. Received: 11 November 2001 / Accepted in revised form: 26 March 2002     

脑室腹腔分流术治疗成人外伤性脑积水分流管的选择

目的探讨脑室一腹腔分流术治疗成人外伤性脑积水时分流管的选择。方法回顾性分析2010年1月至2012年12月脑室-腹腔分流术治疗48例成人外伤性脑积水患者的临床资料。选择抗虹吸分流管的42例,选择非抗虹吸分流管的6例;选择可调压分流阀的28例,选择固定压力分流阀的20例。结果术后1周临床症状缓解37例（77．1％,37／48）症状缓解不明显11例（22．9％,11／48）。头颅CT或MRI复查示分流管脑室端位于脑室内,脑室缩小。术后随访2～38个月,重新再调整阀门压力8例,每例调整2～4次。结论脑室一腹腔分流术仍是治疗成人外伤性脑积水的首选方式,有条件的患者尽量选择可调压抗虹吸分流管,对于不愿选择可调压分流管的患者,可选择低压或中压分流管。     

外伤性脑积水脑室-腹腔分流的临床观察

目的评价脑室-腹腔(V-P)分流对创伤性脑损伤后不同程度的脑积水的治疗效果。方法根据CT影像显示脑室大小,将创伤性脑损伤后脑积水患者50例分为轻度(19例),中度(17例),重度(14例)三组,行V-P分流手术治疗,比较手术前后脑室径与双顶径的比值(V/BP),室周水肿带直径及GOS评分。结果分流三个月后轻中度脑积水组三项指标均显著优于术前(P<0.05),重度脑积水组与术前相比,差异无显著性意义(P>0.05)。结论轻中度外伤性脑积水V-P分流效果较好,重度脑积水患者分流手术后恢复欠佳,临床上对外伤性脑积水患者应尽早发现、及时治疗。     

脑积水脑室-腹腔分流术的并发症及处理对策

目的 探讨脑室-腹腔(VP)分流术后并发症的诊断及其防治方法.方法 回顾性分析l86 例VP 分流术后发生并发症的18 例临床资料.结果 186 例患者术后并发症发生率为9.6% (18 /186),其中颅内感染6 例,腹部感染1 例,皮下隧道感染1 例,分流管堵塞4 例,分流过度2 例,分流不足4 例.结论 预防V...     

Ascites following ventriculoperitoneal shunting in children with chiasmatic-hypothalamic glioma

OBJECT: Optic pathway gliomas in children can involve the optic nerve, chiasm, and hypothalamus. This uncommon, slowly growing tumor can cause hydrocephalus, which usually requires placement of a ventriculoperitoneal (VP) shunt. Symptomatic ascites may occasionally develop as a complication of the VP shunt procedure. The purpose of this study was to assess the risk factors associated with CSF ascites in children with optic pathway gliomas. METHODS: Twenty-two children (ages 4 months to 20 years) with chiasmatic-hypothalamic optic gliomas participated in this study. Four children were diagnosed with a chiasmatic glioma, 7 with a hypothalamic glioma, and 11 with a glioma involving both the optic chiasm and hypothalamus. Twelve children (55%) developed hydrocephalus and required VP shunt placement. Of the 12 shunted children, 4 (33%) developed CSF ascites. The incidence of ascites was not associated with infection, tumor metastasis, or multiple shunt revisions. There was no correlation with the size of the tumor. All 4 children with ascites had tumor involving the optic chiasm or optic nerve. None of the 5 children with pure hypothalamic glioma who underwent VP shunt placement have developed ascites. Among the 7 children suffering from chiasmatic or optic nerve gliomas who developed hydrocephalus, the risk of developing ascites as a complication of VP shunt placement was 57% (4/7). Ventriculoatrial (VA) shunt was the treatment of choice for children with VP shunt-induced ascites. After placement of a VA shunt the ascites subsided. The children did not develop further complications. CONCLUSION: We conclude that glioma involving the optic chiasm or nerve is associated with a high risk of developing ascites following VP shunt placement. VA shunt may be the treatment of choice for children with chiasmatic or optic nerve gliomas who require a CSF diversion procedure.     

脑室-腹腔分流术治疗外伤性脑积水18例临床体会

目的 探讨重型颅脑损伤后脑积水的治疗。方法 对本人1998年1月～2004年8月收治的18例该类患者的临床表现、影像学改变及采用的治疗方法、效果进行回顾性分析。结果 入院时GCS评分3～8分，急性脑积水2例，先行脑室外引流术，直至脑脊液(CSF)澄清，拔除外引流管后又出现脑积水。慢性脑积水16例。18例均行脑室-腹腔分流术。术后症状好转者16例，无变化者1例，因颅内感染死亡1例。结论 颅脑损伤后蛛网膜下腔出血及脑室内积血是引起外伤性脑积水的主要原因，及时复查CT可明确诊断，采用脑室-腹腔分流术治疗有较好的疗效。     

CSF ascites: a rare complication of ventriculoperitoneal shunt surgery

CSF ascites is a very rare complication of ventriculoperitoneal (VP) shunt procedure. No definite explanation has been offered for the inability of the peritoneum to absorb the CSF. Two children who underwent VP shunting for hydrocephalus, presented with ascites 3 (1/2) years and 4 months respectively, after the shunt was placed. The treatment of choice is conversion of the VP shunt to a ventriculoatrial shunt.