脑室-腹腔分流术中分流管腹腔端无需特殊处理

目的 前瞻性探讨脑室-腹腔(V-P)分流术后分流管腹腔端位置的动态变化,确定腹腔端的简单、有效处置方法.方法 回顾性总结采用V-P分流术治疗的40例脑积水患者,脑室端均采用额角穿刺,腹腔端采用剑突下4 cm正中切口,腹膜切开3 mm后将分流管腹腔端置入腹腔内.术后第1、3和7天常规复查头颅CT,同时行腹部平片确定腹腔端分流管位置.结果 CT显示40例均分流效果良好.腹部平片显示术后第1天分流管腹腔端位于盆腔31例,下腹腔5例;术后第3天和第7天分流管腹腔端位于盆腔内分别为35和39例.1例术后第5天发生对侧急性硬脑膜下血肿,家属放弃手术自动出院;余患者平均于术后(11±4)d出院.1例术后1年发生腹腔端感染,控制感染后改行脑室-心房(V-A)分流术;余患者术后随访1个月-2年,无相关并发症发生.结论 采用剑突下正中小切口,可减少手术创伤并缩短手术时间,获得良好的分流效果;分流管腹腔端处置的方法简单、实用,分流管腹腔端绝大多数在术后1 d内降入盆腔内,无需特殊固定和处理.

Abstract：

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

脑室-腹腔分流术中分流管腹腔端的处理

目的探讨脑室-腹腔分流术中分流管腹腔端的处理方法。方法回顾分析我院2014-01—2015-01收治的79例脑室-腹腔分流术中分流管腹腔端的处理方法,腹部采用剑突下正中切口(长4~5cm),腹膜切开3~5mm,确认分流管通畅后将腹腔端置入腹腔内。结果 79例分流患者术后第1天复查头CT见脑室较前缩小57例(72%),无明显变化20例(25%),颅内出血2例(3%)。出院1个月后骨窗压力下降15例(共23例颅骨缺损),意识障碍程度好转10例,术前头痛者均有减轻,颅内感染再次手术拔除分流管2例。所有患者出院后随访12~24个月,其中死亡5例(与分流手术无关),仍昏迷19例(术前昏迷26例),确认分流管腹腔端梗阻1例,再次入院手术。其余患者调压稳定后均病情平稳。结论脑室-腹腔分流术腹部采用剑突下小直切口,腹膜小切口,将分流管置入腹腔内的方法,效果良好。     

成人脑室-腹腔分流术后并发症及其防治

目的探讨成人脑室一腹腔分流术（V—P分流术）后的常见并发症及其防治。方法回顾性分析了62例成人脑积水病例，均经V—P分流术治疗。结果本组62例出院时显著改善52例，轻度改善7例，无改善3例。全部病例术后住院期间按压储液囊无阻塞，弹性良好，其中14例发生并发症而再次手术。结论减少手术操作失误，积极处理原发病，是预防V—P分流术后并发症的关键。     

脑室-腹腔分流术中分流管腹腔端处理方式临床分析

目的通过动态观察脑室-腹腔(V-P)分流术后腹腔端分流管位置的变化,探讨V-P分流术中分流管腹腔端的处理方式与分流效果的关系。方法回顾分析我院采用V-P分流术治疗的33例脑积水患者临床资料,术中均采用穿刺额角脑室置入分流管脑室端,取剑突下正中切口长约4cm,依次切口各层,打开腹膜后置入腹腔端分流管,术中未固定和特殊处理腹腔端分流管。术后定期复查头颅CT,同时行腹部平片观察分流管腹腔端位置的变化。结果术后观察33例患者分流管均通畅,效果良好。随访1个月~1a,其中2例分别在术后7~9个月发生腹腔感染,经控制感染后行脑室-心房(V-A)分流术后痊愈,余患者无发生相关并发症。结论脑室-腹腔分流手术中分流管腹腔端无特殊固定及处理,术后1d大多数分流管腹腔端降入盆腔,术后随访分流效果满意。     

脑室-腹腔分流术中分流管腹腔端置入方法的改进

以往脑室－腹腔分流术中分流管腹腔端的置入多采用开腹的方法，创伤较大。自１９９８年５月以来，我们借鉴介入治疗的Seldinger技术原理，采用同轴穿刺法置入２１例，效果可靠，现介绍如下。１对象与方法适合脑室－腹腔分流术的病人，采用进口一体式或国产分体式分流管，术中分     

体外可调压脑室-腹腔分流术治疗脑积水

脑室-腹腔分流术是目前神经外科治疗脑积水的一种最常用的方法.本院自1997年1月至2004年4月共治疗各类脑积水25例.其中有4例采用体外可调压脑室-腹腔分流术治疗并随访2年,收到较好疗效,现进行总结分析.     

腹腔穿刺置管系统在脑室-腹腔分流术中的应用

目的探讨腹腔穿刺置管系统在脑室-腹腔分流术中的可操作性及安全性。方法 12例脑积水病人采用腹腔穿刺置管系统,以"脐周四点提起法"提起腹壁经脐缘穿刺置入脑室-腹腔分流管腹腔端。3例腹腔镜手术志愿者按上述方法及部位模拟穿刺置入脑室-腹腔分流管,并借助腹腔镜观察穿刺置管全过程。计算穿刺置管时间、观察腹腔穿刺置管成功率及安全性。结果置管成功率为100%,平均穿刺置管时间4min,均未出现腹腔内出血及腹腔内脏器损伤。结论腹腔穿刺置管系统应用于脑室-腹腔分流术具有操作简单、安全、微创、成功率高、不遗留手术瘢痕等优点。     

自制腹腔穿刺置管针在脑室-腹腔分流术中辅助应用临床研究

采用自制腹腔穿刺置管针对36例脑积水患者施行脑室-腹腔分流术,通过计算穿刺置管时间,评价腹腔穿刺置管成功率和安全性。结果显示,置管成功率达100%、平均穿刺置管时间5 min,术中无一例出现腹腔内出血或脏器损伤。表明腹腔穿刺置管针应用于脑室-腹腔分流术操作简单、安全、微创、手术成功率高、并发症少,易于推广。     

腹腔端微创置管技术在脑室-腹腔分流术中的应用（附85例分析）

目的探讨在不用腹腔镜的情况下,微创分流管腹腔端置管技术在脑室-腹腔分流术中的安全性和可行性。方法回顾性分析85例采用微创分流管腹腔端置管技术病人的手术指征、手术技巧及并发症等。本组采用人工气腹,腹部行5mm小切口,在不使用腹腔镜的情况下置入分流管腹腔端。结果术后发生颅内感染2例,脑室端梗阻2例,脑室端异位’1例和腹腔端包裹性积液1例,无腹腔端异位或腹腔脏器损伤发生。结论微创分流管腹腔端置管技术安全有效,具有操作简单、损伤轻微、节省医用资源、减少费用、并发症少等特点,易于在各级医院开展。     

脑积水脑室-腹腔分流术失败后处理方式的探讨

目的 探讨脑积水脑室-腹腔(V-P)分流术失败后的处理方式.方法 回顾性分析我院2005年7月至2010年7月收治的72例脑积水V-P分流术失败患者的临床资料.结果 本组无死亡病例.行再次V-P分流术53例,脑室-心房(V-A)分流术14例,脑室镜下第三脑室底造瘘术3例,去除分流管2例.近期有效率为97％,2例1个月内又出现分流失败.结论 脑积水V-p分流术失败后,针对不同的失败原因进行积极处理,可取得较好疗效.     

Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus

We aimed to compare the accuracy of different shunt catheter approaches to the lateral ventricle in adults with hydrocephalus. We conducted a retrospective review of 138 consecutive patients with hydrocephalus undergoing freehand initial shunt surgery. Of these, 79 had a post-operative brain scan and therefore the results were available for analysis. Scans were graded for successful catheter tip placement in the ventricular target zones: the frontal horn for frontal and occipital approaches, and the atrium for the parietal approach. Ventricular target zones were successfully catheterized in 85% of parietal and 64% of frontal shunts (this difference is not statistically significant). In contrast, only 42% of occipital shunts were correctly placed (p < 0.01). Therefore, parietal and frontal catheters are more likely to be placed successfully in the target ventricle. This may be due to the smaller range of successful trajectories open to the occipital approach. Solutions to this problem may include using the theoretically favourable frontal approach for freehand surgery or using stereotactic guidance.     

Geometric information is required for allothetic navigation in mice

In tasks for allothetic navigation, animals should orientate by means of distal cues. We have previously shown that mice use several forms of information to navigate, among which geometry, i.e. the shape of the environment, seems to play an important role. Here we investigated whether geometric features of the environment are necessary for allothetic navigation in mice. Mice were trained to navigate in a circular water maze by means of four distal landmarks distributed either symmetrically (symmetry group) or asymmetrically (asymmetry group) around the maze. Thus, mice could locate a hidden platform by either differentiating the landmarks based on their intrinsic features (symmetry group) or in addition by geometric information, i.e. based on the relative distances between landmarks (asymmetry group). Data indicated that place learning occurred only in the asymmetry group. The results support the idea that mice navigate by using the relational properties between distal landmarks and that geometric information is required for proper allothetic navigation in this species.     

Otolithic information is required for homing in the mouse

Navigation and the underlying brain signals are influenced by various allothetic and idiothetic cues, depending on environmental conditions and task demands. Visual landmarks typically control navigation in familiar environments but, in the absence of landmarks, self‐movement cues are able to guide navigation relatively accurately. These self‐movement cues include signals from the vestibular system, and may originate in the semicircular canals or otolith organs. Here, we tested the otolithic contribution to navigation on a food‐hoarding task in darkness and in light. The dark test prevented the use of visual cues and thus favored the use of self‐movement information, whereas the light test allowed the use of both visual and non‐visual cues. In darkness, tilted mice made shorter‐duration stops during the outward journey, and made more circuitous homeward journeys than control mice; heading error, trip duration, and peak error were greater for tilted mice than for controls. In light, tilted mice also showed more circuitous homeward trips, but appeared to correct for errors during the journey; heading error, trip duration, and peak error were similar between groups. These results suggest that signals from the otolith organs are necessary for accurate homing performance in mice, with the greatest contribution in non‐visual environments. © 2015 Wiley Periodicals, Inc.     

The hippocampus is required for short-term topographical memory in humans

The hippocampus plays a crucial role within the neural systems for long-term memory, but little if any role in the short-term retention of some types of stimuli. Nonetheless, the hippocampus may be specialized for allocentric topographical processing, which impacts on short-term memory or even perception. To investigate this we developed performance-matched tests of perception (match-to-sample) and short-term memory (2 s delayed-match-to-sample) for the topography and for the nonspatial aspects of visual scenes. Four patients with focal hippocampal damage and one with more extensive damage, including right parahippocampal gyrus, were tested. All five patients showed impaired topographical memory and spared nonspatial processing in both memory and perception. Topographical perception was profoundly impaired in the patient with parahippocampal damage, mildly impaired in two of the hippocampal cases, and clearly preserved in the other two hippocampal cases (including one with dense amnesia). Our results suggest that the hippocampus supports allocentric topographical processing that is indispensable when appropriately tested after even very short delays, while the presence of the sample scene can allow successful topographical perception without it, possibly via a less flexible parahippocampal representation.     

Myosin II activity is required for severing-induced axon retraction in vitro

Understanding the mechanistic basis of the response of neurons to injury is directly relevant to the development of effective therapeutic approaches aimed at the amelioration of nervous system damage. Axons retract in response to severing. We investigated the mechanism of axon retraction in response to severing in vitro, testing the hypothesis that actomyosin contractility drives severing-induced axon retraction. Axon retraction commenced within 5 min following severing and correlated with actin filament accumulation at the site of severing. Depolymerization of actin filaments prevented retraction, demonstrating that actin filaments are required for severing-induced axon retraction. Direct inhibition of myosin II, using blebbistatin, minimized axon retraction in response to severing. Blocking RhoA-kinase (ROCK), a modulator of myosin II activity, inhibited axon retraction. Similarly, inhibiting myosin light chain kinase (MLCK) with a cell-permeable pseudo-substrate peptide also inhibited axon retraction. These data demonstrate that myosin II activity is required for severing-induced axon retraction in vitro, and suggest myosin II as a target for therapeutic interventions aimed at minimizing retraction following severing in vivo.