颅内蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征2例报告并文献分析

目的总结颅内蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的临床诊治经验。方法对2例颅内蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征患者的临床表现、影像学检查及术中所见结合文献进行分析。结果2例患者分流术后分别出现发作性眩晕和剧烈头痛,均伴恶心、呕吐,采取分流管头端调整术,并改用中压虹吸分流阀后症状明显改善。结论正确认识颅内蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的病理生理过程,针对具体情况选择合适的治疗方案尤其重要。最有效的预防方法是在严格把握手术适应症的情况下选择可调压或抗虹吸分流管。     

囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿

目的 研究非开颅术（囊肿－腹腔分流术）治疗颅内蛛网膜囊肿的手术方法。方法 对颅内表浅部位的蛛网膜囊肿,行囊肿－腹腔分流术。结果 ５１例１５岁以下的病儿行囊肿－腹腔分流术,２３例得到随访。１年内囊肿完全消失率７４％,其余病例逐渐缩小,总体有效率（囊肿消失和缩小）１００％。有３例颅内分流管在囊壁外,再次行分流管调整术。结论 以囊肿－腹腔分流术代替传统的开颅术切除囊肿,具有手术简单、有效、并发症少、无复     

囊肿/脑室-腹腔分流术治疗鞍区蛛网膜囊肿一例

患者女,43岁。因头胀痛渐加重2个月伴走路不稳而行头颅CT及MRI检查,提示鞍上蛛网膜囊肿,大小约4．2 cm×3cm×3cm,伴梗阻性脑积水。神经系统查体见行走不稳,双眼视乳头轻度水肿,余无特殊异常发现。手术方法：局麻下安装脑立体定向仪头架后行CT定位扫描,以蛛网膜囊肿壁与右侧脑室前角交界处为靶点计算其X、Y、Z轴的坐标。回到手术室后局麻下于眉间上9cm右侧旁开2．5cm处     

裂隙脑室综合征

裂隙脑室综合征是脑室腹腔分流术后过度引流引起的以脑室变小、颅内压增高症状反复发作为主要临床表现胡一种综合征.治疗主要根据引起症状的不同原因采取相应的处理,内科治疗主要是对症处理,如抗偏头疼药物以及激素的使用,可以在一定程度上缓解症状,但最终的治疗主要在于外科手术如分流调整术、颞下减压术等.     

脑室-腹腔分流术后肛门脱管1例

1 临床资料 患者男,9岁,因车祸于1995-04-12行硬膜下血肿清除术,术后1月清醒,术后40d因“外伤性脑积水”使用进口分流管行右侧脑室-腹腔分流术。1995-10-12行颅骨缺损修补术,术后2月出现高烧,左下腹痛,腹膜刺激征阳性,经反复抗感染后,体温正常,腹痛消失而出院,出院第2天,患者大便时肛门内露出分流管腹腔端。1996-01～08以“肠穿孔”第三次入院。入院查体:神志清楚,精神佳,左侧肢体痉挛瘫,肛门内脱出引流管10cm,管端完整无破损。按压头部压力泵流出清亮脑脊液,脑脊液常规、生化检验大致正常,细菌培养阴性。腹部B超检查正常,住院后行腹腔探查拔管术,术中见大网膜向左下移位包裹分流管,有较多粘连带使回肠粘连成“M”状。沿分流管寻找,在乙状结肠中、下部可见穿孔处,在此剪断分流管,两断分别拔出。修补肠穿孔。术后20d行脑室-心房分流术,痊愈出院。     

腹腔分流术治疗儿童巨大蛛网膜囊肿20例报告

颅内蛛网膜囊肿是儿童常见的先天性畸形，通常出现癫痫和部分神经功能障碍时需手术治疗。以往的外科治疗方法以开颅行囊肿壁的大部分切除为主，但对于较大和巨大的蛛网膜囊肿采取此方法创伤大、易复发，临床症状不易消失。自1996年3月至2002年6月，我科共实施囊肿一腹腔分流术治疗儿     

囊肿-腹腔分流术治疗不同类型的儿童颅内蛛网膜囊肿

颅内蛛网膜囊肿是儿童常见疾病．以往治疗以开颅囊肿切除术、囊肿切除 脑池交通术等为主要方法,但存在创伤大、易复发、临床症状不易消失等缺点,后来许多学者对浅表部位的囊肿采用囊肿-腹腔分流术进行治疗,取得了较好的疗效。但对于较深部位的囊肿采用囊肿-腹腔分流术尚未见     

囊肿-腹腔分流术治疗颅内蛛网膜囊肿67例临床分析

目的探讨囊肿-腹腔分流术治疗颅内蛛网膜囊肿的临床疗效及安全性。方法回顾67例蛛网膜囊肿患者采用囊肿-腹腔分流术治疗的临床资料。结果 68.75%半年内蛛网膜囊肿消失,其余囊肿不同程度缩小,随着时间延长,缩小程度进一步加大,直到囊肿消失、颅内压消失,受压的脑组织恢复。结论应用囊肿-腹腔分流术治疗蛛网膜囊肿安全有效。     

囊肿-腹腔分流术治疗儿童中线部位巨大蛛网膜囊肿

目的 总结囊肿-腹腔分流手术治疗儿童中线部位巨大蛛网膜囊肿的临床经验.方法 回顾性分析2005年1月至2011年12月应用囊肿-腹腔分流手术治疗的儿童中线部位巨大蛛网膜囊肿的临床资料,总结分析其发病特点合并畸形及预后情况.结果 17例患儿接受囊肿-腹腔分流手术,多因头围增大就诊或孕期超声发现囊肿,多伴有邻近脑组织的发育不良,可有一定程度的生长发育落后,经分流手术后症状消失,发育改善.结论 儿童中线部位巨大蛛网膜囊肿早期进行分流手术简单、有效,预后较好.     

囊肿-腹腔分流术治疗老年人枕大池蛛网膜囊肿

<正>自2003年1月至2012年12月,共收治老年人枕大池蛛网膜囊肿49例,其中16例有颅内压增高症状,均采取囊肿-腹腔分流手术治疗,效果明显,现报道如下。1临床资料1.1一般资料本组患者16例均符合枕大池蛛网膜囊肿诊断,其中男11例,女5例;年龄60~78岁,平均69.2岁。病史2~23年,平均24年。头痛头晕9例,头痛伴恶心呕吐2例,存     

Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study

Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.     

Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst

Serious complications following installation of a cyst-peritoneal shunt in an 8-year-old boy with asymptomatic arachnoid cyst in the middle cranial fossa are reported. Highly elevated intracranial pressure without association of ventriculomegaly seen in this patient indicates slit ventricle syndrome caused by malfunction of the cyst-peritoneal shunt. This phenomenon is worth recognizing as a possible consequence of cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst.     

Short-term dexamethasone treatment for symptomatic slit ventricle syndrome

Objective The objective was to report our positive experience of using dexamethasone to treat 13 patients with symptomatic slit ventricle syndrome (SVS).Methods Thirteen SVS patients who received dexamethasone during acute episodes were studied. The etiology for hydrocephalus was prematurity and intraventricular hemorrhage in 9 patients and neonatal meningitis, chorioamnionitis, Dandy–Walker variant, and congenital in 1 case each. The shunt was inserted at 1.8±1.0 months of age and SVS was diagnosed at 4.9±3.2 years of age.Results All patients reported relief and shorter duration of symptoms with dexamethasone. Surgical intervention was decided upon and carried out within 11±8 months of SVS diagnosis in 9 out of 13 patients. The other 4 are being monitored and continue to receive dexamethasone when needed.Conclusions Dexamethasone appears to be a useful treatment in acutely increased intracranial pressure caused by SVS. It can provide temporary relief during the decision-making process of whether and when to perform surgery.A commentary on this paper is available at     

Classification and management of the slit ventricle syndrome

A total of 32 patients with overdrainage of CSF, fulfilling the radiological and clinical criteria for collapsed ventricles (slit ventricles), were classified into acute, subacute and chronic forms. The basis of classification into these categories was neurologic symptomatology. The majority (29 patients) originally had a ventriculoatrial shunt and 3 had ventriculoperitoneal shunts. Operative correction was performed in 23 patients (insertion of a high pressure valve in 18 and an antisiphon device in 5). Of these, 5 had acute, 10 subacute, and 6 chronic symptoms. Two patients without symptoms were operated on also. During the follow-up period, which varied from 2 to 11 months, no patient has shown recurrence of the original symptoms of the slit ventricle syndrome; two patients developed subacute signs and an antisiphon device was inserted in addition to the high-resistance valve. On the basis of this series, it is concluded that the slit ventricle syndrome can also develop in patients with an atrioventricular shunt and can be treated by preventing further overdrainage of CSF. Though the results are acceptable by present methods, the need for a servo-regulated shunt persists. The surgical correction should preferably be performed before the acute phase. A flowchart is presented for management of a child with suspected slit ventricles.     

CSF overdrainage in shunted intracranial arachnoid cysts: a series and review

Background  Cerebrospinal fluid (CSF) overdrainage in hydrocephalus is well recognized. Overshunting following cysto-peritoneal (CP) drainage in patients with arachnoid cysts (AC) is rarely documented. Aim  We report five patients with acquired Chiari malformation I and three with posterior fossa overcrowding due to excessive CSF drainage in shunted intracranial ACs. We review our observations and discuss the current knowledge on the pathogenesis and management of this complication. Patients and methods  The medical records of the eight patients were analyzed in regard to clinical manifestation, cyst and shunt characteristics, management, and outcomes. Results  Mean age of the patients was 5.5 years. After an average interval of 5 years, five patients developed symptoms related to hindbrain herniation and three to severe shunt overdrainage following CP shunting. Several management modalities were utilized that achieved a good result in seven instances. Discussion  Some shunted ACs may evolve with overdrainage syndromes. Posterior fossa overcrowding and tonsillar herniation constitute their most severe forms. CSF hypotension, bone changes, venous engorgement, and probably cerebral chronic edema at the posterior fossa constitute the main factors involved in the pathogenesis of this entity. We also review previous instances of acquired Chiari malformation originating after AC shunting. Conclusions  Posterior fossa overcrowding and acquired Chiari I malformation can develop after excessive CSF drainage of intracranial ACs. Overshunting manifestations require prompt recognition and management. Preventive measures consist of making a stringent selection of cases being considered for surgery, avoiding CP drainage, and placing of a programmable valve as initial treatment of intracranial ACs if shunting is considered.     

Electroencephalographic findings and epilepsy in the slit ventricle syndrome of shunt-treated hydrocephalic children

Overdrainage of the cerebrospinal fluid (CSF) and collapse of the ventricles, slit ventricles (SLV), can cause clinical symptoms and result in the slit ventricle syndrome (SLVS). The EEG changes and the frequency and type of epilepsy in patients with SLV was analysed from a material of 113 shunt-treated hydrocephalic children. During the follow-up time (mean 8.9 years), 63 patients (56%) had developed SLV. The age at initial shunting was significantly lower (1.2 years) in patients who developed SLV than for those who did not (2.7 years). After initial shunting generalized spike and sharp wave activity (SWA) developed more frequently in patients who developed SLV (81%) than in those who did not (54%). Severe generalized SWA developed almost entirely in patients in the SLV group. This severe generalized SWA disappeared from the EEG in patients after treatment of the SLVS. Epileptic seizures appeared after initial shunting in 44% of patients in the SLV group but in only 6% of the non-SLV group. Treatment of the SLVS decreased the frequency of epilepsy to a level corresponding with the non-SLV group. Repeated EEG evaluation of shunt-treated hydrocephalic children is a valuable aid in follow-up. If EEG abnormality appears after initial shunting, especially SWA, shunt malfunction and overdrainage of the CSF should be suspected.     

颅内蛛网膜囊肿-腹腔分流术后分流管依赖二例并文献复习

目的 探讨颅内蛛网膜囊肿-腹腔分流术后并发分流管依赖的可能机制、影像学特征及治疗方法.方法 分析2例蛛网膜囊肿行囊肿-腹腔分流术后并发分流管依赖的诊治过程,并结合文献进行讨论和总结.结果 2例均表现为分流管功能丧失后继发严重颅高压症状,其中1例行侧脑室-腹腔分流术;另1例先行囊肿-腹腔分流术,1个月后分流管堵塞,改行腰大池-腹腔分流术.经治疗后2例均痊愈出院,预后良好.结论 分流管依赖是继发于分流管功能下降或丧失,临床表现呈持续进展性颅内压增高;影像学上可观察到侧脑室正常或轻度缩小,原囊肿短期内可复现增大;解除分流管梗阻或重新建立脑脊液引流渠道是安全有效的治疗方法.     

Infantile hydrocephalus and the slit ventricle syndrome in early infancy

Slit ventricle syndrome is well known as a complication in the treatment of hydrocephalus by shunting. It is generally considered to be a chronic (but not acute) complication, occurring years after the shunt procedure; there has been no report of this syndrome occurring before 1 year of age. The authors present infantile cases that developed a severe form of this syndrome shortly after shunt procedures and discuss the pathophysiology in comparison to experience with older cases. The causative factor was thought to be extremely low intracranial pressure with resultant microcephalus created by double or multiple shunt placement. The condition resulted in rapid onset of coma and respiratory arrest, which was successfully treated by subtemporal decompression or placement of an antisiphon device, with insertion of a higher pressure valve. The specific characteristics of infantile hydrocephalus are analyzed in the light of this complication from a series of 58 treated infants. In a follow-up of over 1 year in 42 cases, analysis revealed that slit ventricle occurs most frequently in immature young infants shunted before 1 month of age (85.7% or 18/21 cases). In contrast, subdural hematoma after shunting is an extremely rare phenomenon in premature or mature neonates. Slit ventricles were thought to result from high intracranial compliance due to the softer brain and more markedly widened cranial sutures of infantile hydrocephalus in the younger age group. The functioning period of the initial shunt was also much shorter in younger infants, and this may be because the ventricular shrinkage to a slit can cause shunt malfunction with or without developing the slit ventricle syndrome. The authors emphasize that development of slit ventricle after shunt placement should be prevented before it causes a damaging or, occasionally, a life-threatening condition.     

Cranial disjunction and visual failure in a slit ventricle syndrome with patent shunt

A 6.5-year-old child who received a shunt at 3 weeks of age for triventricular hydrocephalus related to his congenital toxoplasmosis developed symtoms of intracranial hypertension and papilloedema. Computed tomographic scan demonstrated slit ventricles. The shunt device was shown to be patent on isotope transit study. Spontaneously the cranial sutures widened and headaches disappeared, but loss of vision occurred and did not reverse despite optic nerve sheath fenestration. We suspect that a rapid drop in intracranial pressure played a role in the pathogenesis of our patient's blindness. This possible complication should be taken into account when calvarial expansion is planned in a patient with an intracranial hypertension syndrome with papilloedema in the presence of slit ventricles and a patent shunt.