Ommaya囊植入治疗颅脑损伤术后脑积水合并减压对侧硬膜下积液

目的探讨颅脑损伤术后脑积水合并去骨瓣减压对侧硬膜下积液的治疗方法。方法 2004～2010共收治颅脑损伤术后脑积水合并去骨瓣减压对侧硬膜下积液患者14例,先行Ommaya储液囊植入引流硬膜下积液,必要时对头部骨窗给予弹性绷带加压包扎和腰椎穿刺引流,待硬膜下积液消失后观察1～2周无复发时再行脑室-腹腔分流术。结果术后随访0.5～1年,无硬膜下积液复发、无积液演变成血肿等。患者脑积水症状均逐渐稳定,复查头颅CT示脑室缩小或接近正常,中线结构居中。结论 Ommaya囊植入治疗颅脑损伤术后脑积水合并去骨瓣减压对侧硬膜下积液是比较有效的方法。     

Ommaya囊在低龄颅后窝肿瘤术后脑积水中的应用

目的 探讨Ommaya囊在低龄(＜3岁)颅后窝肿瘤术后脑积水中的应用效果.方法 回顾性分析2018年12月至2019年12月收治的7例低龄颅后窝肿瘤术后合并脑积水患儿的临床资料.7例均采用置入Ommaya囊的方法治疗脑积水,并随访3个月.结果 7例患儿在置入Ommaya囊后,通过间断穿刺抽液,脑积水症状均缓解,其中1例...     

脑积水合并颅内感染的治疗策略

目的探讨脑积水合并颅内感染的治疗策略。 方法选择自陆军总医院附属八一脑科医院2011年1月至2014年8月18例脑积水合并颅内感染的病例,其中15例需要行脑脊液外引流术,3例间断行腰椎穿刺控制颅内压,10例轻中度感染者只予以单纯静脉抗感染治疗,8例感染较重者应用鞘内注射抗生素+静脉抗感染联合治疗。感染控制后6例行内镜第三脑室底造瘘术,11例行分流手术,1例放弃治疗,比较内镜治疗组及分流治疗组间感染控制的天数、二重感染发生率及总体并发症发生率,利用SPSS 16.0统计分析软件对资料进行统计。 结果感染控制后6例行内镜第三脑室底造瘘术,11例行分流手术,1例放弃治疗,内镜治疗组感染控制的天数平均（14.6±1.7）d,二重感染率为0,术后并发症发生率为33.33%,分流治疗组感染控制的天数平均（22.3±3.4）d,二重感染率为18.2%,术后并发症发生率为45.45%。内镜治疗组及分流治疗组间感染控制的天数及二重感染率有明显差异（P<0.05）,而术后并发症总发生率没有明显差异（P>0.05）。 结论脑积水合并颅内感染治疗难度大,并发症多,在控制感染、避免二重感染发生率方面内镜手术较分流手术有优势,内镜手术应作为脑积水合并颅内感染的首选治疗方法。     

经Ommaya囊放液试验在正常压力性脑积水术前评估中的应用

目的 探讨经Ommaya囊放液试验在正常压力性脑积水术前评估中的应用价值.方法 选择2013年1月至2018年1月收治的56例正常压力性脑积水.至少2次及以上Tap试验结果阴性,进一步行侧脑室Ommaya囊置入,并经Ommaya囊脑脊液放液试验或持续引流试验,根据评估结果制定相应治疗方案.结果 9例单次放液试验后症状改...     

锥颅引流术联合Ommaya囊置入术治疗老年高血压性脑出血破入脑室

目的 探讨锥颅引流术联合Ommaya囊置入术治疗老年高血压性脑出血破入脑室的效果。方法 回顾性分析2019年3月至2020年11月采用锥颅引流术+Ommaya囊置入术治疗的11例老年高血压性脑出血破入脑室的临床资料。结果 术后出现肺部感染6例,术后1周内行气管切开3例;术后再出血1例,放弃治疗出院。术后没有出现颅内感染,没有出现脑积水。出院后随访1年,GOS评分5分2例,4分2例,3分5例,2分1例,1分1例。结论 锥颅引流术+Ommaya囊置入术治疗老年高血压性脑出血破入脑室,创伤小,效果良好。     

Ommaya囊植入治疗新型隐球菌性脑膜炎

目的研究经Ommaya囊植入侧脑室给药在新型隐球菌性脑膜炎的治疗效果。方法对我科收治的22例行Ommaya囊植入与否的新型隐球菌性脑膜炎患者的临床资料进行回顾性分析。结果 6例行Ommaya囊植入治疗的新型隐球菌性脑膜炎患者均治愈,治愈率6/6,平均住院天数(105.3±18.1)d,其两性霉素B平均应用天数(75.0±18.1)d。对照组16例,治愈6例,其治愈者平均住院天数(150.0±32.2)d、两性霉素B平均应用天数(139.6±29.5)d。两组临床疗效之间有显著性差异(P0.05)。结论 Ommaya囊植入治疗新型隐球菌性脑膜炎可提高治愈率,缩短疗程。     

颅内压监测指导下穿刺引流+Ommaya囊置入术治疗基底节区出血破入脑室

目的 探讨颅内压监测指导下穿刺引流+Ommaya囊置入术高血压性基底节区出血破入脑室的疗效。方法 回顾性分析2016年1月至2019年1月在颅内压监测指导下穿刺引流+Ommaya囊置入术治疗的40例高血压性基底节区出血破入脑室的临床资料。结果 术后1周内均顺利拔除血肿腔引流管。术后无颅内感染及脑积水。术后3 d颅内压平均（25.6±4.3）mmHg,GCS评分平均（9.4±3.6）;术后1周,颅内压平均（18.7±3.8）mmHg,GCS评分平均（10.3±2.2）。术后1周颅内压明显下降（P<0.05）,术后1周GCS评分无明显变化（P>0.05）。术后6个月,预后良好率为70%(28/40)。结论 颅内压监测指导下穿刺引流+Ommaya囊置入术治疗基底节区出血破入脑室,手术创伤小,并发症少,可以有效提高疗效。     

立体定向穿刺加Ommaya囊置入术在颅内囊性病变中的临床应用

目的探讨立体定向穿刺术和Ommaya囊置入术在治疗颅内囊性病变中的应用技巧及疗效。 方法回顾性分析上海华山医院伽马分院2012年11月至2013年4月收治的3例不同颅内囊性病变患者,对该3例诊断明确的颅内囊性患者(分别为右颞转移瘤、左侧CPA神经鞘瘤、颅内多发病变)在立体定向穿刺后置入Ommaya囊,再根据具体病情给予囊腔逐渐抽吸,使囊液逐渐减少至最少,给予伽玛刀的治疗方法。 结果3例病例均在多次抽取囊液后行伽玛刀治疗,无不适反应,均未出现皮肤感染、颅内感染、硬膜外血肿等因手术操作导致的并发症。 结论治疗颅内囊性病变,尤其是高龄病人或由于其他原因不能耐受全麻手术的患者时,立体定向加Ommaya囊置入术不失为一种简便、经济、有效、微创的好方法。     

Ommaya储液囊在脑肿瘤并发脑积水中的应用

目的探讨Ommaya储液囊在脑肿瘤并发脑积水中的临床应用效果。方法回顾分析江苏大学附属武进医院神经外科2012年6月至2014年6月收治的4例颅内肿瘤并发脑积水患者,应用Ommaya储液囊治疗。结果 1例患者的症状完全缓解,2例好转,1例自动出院。结论 Ommaya储液囊在脑肿瘤并发脑积水中的临床应用效果良好,临床安全性可靠。     

立体定向Ommaya囊置入抽吸术治疗脑脓肿

目的寻找一种治疗脑脓肿的微创手术方法及给药途径,避免复发后再次手术.方法CT引导下,通过立体定向技术将Ommaya囊置入脓腔,多次抽吸脓汁并注入敏感抗生素.结果12例脑脓肿患者治愈10例,显效2例,无手术死亡、致残.结论立体定向ommaya囊置抽入吸术,能提高脑脓肿的治愈率,避免多次穿刺.     

Ommaya储液囊植入术治疗隐球菌性脑膜炎临床观察

目的观察Ommaya储液囊植入术治疗隐球菌性脑膜炎的临床疗效。方法回顾性分析我院2002—2010年收治的27例隐球菌性脑膜炎患者临床资料,其中Ommaya储液囊治疗组10例,采用两性霉素B、氟康唑治疗、Ommaya储液囊治疗。非Ommaya储液囊治疗对照组17例,只给予两性霉素B+氟康唑治疗。结果 Ommaya储液囊治疗组隐球菌转阴时间(20±8)d,明显短于对照组的(35±10)d,两者比较差异具有统计学意义(P<0.05)。Ommaya储液囊治疗组治愈率60.0%,总有效率90.0%,病死率10.0%,好于对照组(治愈率29.4%,总有效率47.1%,病死率17.6%),两者疗效比较差异有统计学意义(P<0.05)。结论植入Ommaya储液囊能有效改善症状,减少并发症,提高治愈率、好转率,降低病死率,值得临床进一步推广。     

Ommaya囊结合侧脑室外引流治疗重度脑室出血的临床研究

目的探讨Ommaya囊穿刺引流结合侧脑室外引流在重度脑室出血中的应用及意义。方法将我科2007年2月至2012年2月收治的46例重度脑室出血患者随机分为:Ommaya囊结合侧脑室外引流治疗组和单纯侧脑室外引流组,将两组患者疗效进行对比分析。结果 Ommaya囊治疗组的交通性脑积水及颅内感染发生率明显低于单纯脑室外引流组(P0.05),术后3个月GOS评分:Ommaya囊治疗组良好8例,中残10例,重残3例,死亡3例;单纯外引流组良好5例,中残4例,重残8例,死亡5例。Ommaya囊治疗组治疗有效率高于单纯外引流组(P0.05)。结论 Ommaya囊穿刺引流结合侧脑室外引流治疗重度脑室出血,可以降低颅内感染及脑积水发生率,改善患者预后,提高生存质量,是脑室出血安全、有效的治疗方法。     

脑室-腹腔分流术后颅内感染的处理经验

目的总结脑室-腹腔分流术后颅内感染的临床特点和治疗效果。方法 2003年1月至2009年1月行脑室-腹腔分流术治疗脑积水患者254例,其中11例分流术后并发颅内感染。对颅内感染者在脑脊液细菌培养和药敏试验结果出来前,通过腰椎穿刺置管鞘内注射可在鞘内应用的广谱抗生素,并持续引流感染的脑脊液;细菌培养和药敏试验结果出来后,选用敏感抗生素鞘内注射;10例病情严重者拔除分流装置,行脑室外引流。结果 11例患者,1例经腰椎穿刺置管鞘内注射抗生素后治愈,10例不断调整引流装置同时脑室内注入抗生素后治愈。结论脑脊液脑室外引流、鞘内或脑室内注射抗生素,以及必要时拔除分流装置是治疗脑室-腹腔分流术后颅内感染的主要措施。     

颅内感染并发脑积水患者低钠血症处理

目的探讨颅内感染后脑积水患者低钠血症的发生及治疗方法。方法对26例颅内感染后出现低钠血症的脑积水患者的临床资料进行了观察和分析。结果经过治疗患者症状明显改善,血钠水平在3～8 d后逐渐恢复正常。结论颅内感染后脑积水患者可出现低钠血症,属于脑性盐耗综合征,经过积极治疗一般转归良好。     

Cyst fenestration and Ommaya reservoir placement in endoscopic transcortical transventricular approach for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly

The efficacy of the endoscopic transcortical transventricular approach (ETTA) for craniopharyngioma in the third ventricle with hydrocephalus has been reported focusing on its reduced invasiveness. On the other hand, suprasellar craniopharyngioma without ventriculomegaly is generally surgically managed by craniotomy or the endoscopic endonasal approach (EEA). Here, we report an elderly patient who received cyst fenestration and Ommaya reservoir placement in ETTA for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly. The ETTA as a less invasive procedure is feasible in patients not only with intraventricular craniopharyngioma but also with suprasellar craniopharyngioma without hydrocephalus provided a navigational system is applied and the surgeon has ample experience with transcranial endoscopic procedures.     

The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity

Objective The aim of this study is to retrospectively evaluate a series of consecutive patients affected by post-hemorrhagic hydrocephalus in prematurity, treated with an implant of an Ommaya reservoir followed by ventriculo-peritoneal (VP) shunt and/or endoscopic third ventriculostomy (ETV) to evaluate the safety and efficacy of these treatment options in the management of the condition. Methods Between 2002 and 2005, 18 consecutive premature patients affected by intra-ventricular haemorrhage (IVH) grades II to IV, presenting with progressive ventricular dilatation, were operated for implant of an intra-ventricular catheter connected to a sub-cutaneous Ommaya reservoir. Cerebrospinal fluid was intermittently aspirated percutaneously by the reservoir according with the clinical requirements and the echographic follow-up. The patients who presented a progression of the ventricular dilatation were finally operated for VP shunt implant or ETV according with the MRI findings. Results One patient had grade II, 5 had grade III, and 12 had grade IV IVH. The mean age at IVH diagnosis was 5.2 days; the mean age at reservoir implant was 17.3 days. The Ommaya reservoir was punctured on an average basis of 11.4 times per patient (range 2–25), and the mean interval between aspirations was 2.7 days. The mean CSF volume per tap was 20 ml. One patient died for pulmonary complications during the study period. Out of the 17 survivors, 3 did not develop progressive ventricular dilatation, and their reservoir was removed; 14 developed progressive hydrocephalus, 5 of whom were implanted with a VP shunt and 9 received an ETV. Amongst the five shunted patients, two were re-admitted for shunt malfunction and had their shunt removed after ETV after 6.1 and 20.5 months, respectively. Amongst the nine patients who received an ETV, five had to be re-operated for VP shunt implant at an average interval of 2.17 months (range 9–172 days) because of increasing ventricular dilatation. Two of them had a redo third ventriculostomy with shunt removal at 11 and 25.1 months, respectively, after insertion. The first was reimplanted with a VP shunt 4 days later; the second remains shunt free. Therefore, at the end of the follow-up period, 10 out of 17 children affected by post-hemorrhagic hydrocephalus in prematurity were shunt free (59%). Conclusions The combination of Ommaya reservoir, VP shunt, and the aggressive use of ETV as a primary treatment or as an alternative to shunt revision allowed for a significant reduction of shunt dependency in a traditionally shunt-dependent population. Further studies are warranted to optimise the algorithm of treatment in these patients.     

Optimal implantation of Ommaya reservoirs for cystic metastatic brain tumors preceding Gamma Knife radiosurgery

Introduction: Although Ommaya reservoir implantation is effective in reducing the target volume of cystic brain metastases preceding stereotactic radiosurgery, adequate volume reduction cannot be achieved in some cases, and the factors leading to failure in volume reduction have not been clearly identified. In this study, we investigated the factors leading to failure in volume reduction after use of the Ommaya reservoir. Materials and methods: Between December 2007 and February 2015, 38 consecutive patients with 40 cystic metastases underwent Ommaya reservoir implantation at our institution. The patient characteristics, treatment parameters, and all available clinical and neuroimaging follow-ups were analyzed retrospectively. Results: The rate of volume reduction was significantly related to the location of the tube tip inside the cyst. By placing the tip at or near the center, 58.7% reduction was achieved, whereas reduction of 42.6% and 7.7% occurred with deep and shallow tip placement, respectively (p = 0.011). Although there was no additional surgery in the center placement group, additional surgeries were performed in 5 out of the 23 deep and shallow cases due to inadequate volume reduction. No other factors were correlated with successful volume reduction. Conclusion: For adequate volume reduction using the Ommaya reservoir in the treatment of cystic brain metastases prior to stereotactic radiosurgery, the tip of the reservoir tube should be placed at the center of the cyst.     

The role of an Ommaya reservoir in the management of children with cryptococcal meningitis

Cryptococcal meningitis is the most common life-threatening fungal infection and is associated with high mortality in children. Amphotericin B plus flucytosine and fluconazole is the optimal current therapy. Implantation of an Ommaya reservoir for intraventricular infusion of medication and aspiration of cerebrospinal fluid (CSF) for the treatment of increased intracranial pressure (ICP) has been reported. Intraventricular injection of amphotericin B through an Ommaya reservoir in children with cryptococcal meningitis has not been reported previously. We report two children who had cryptococcal meningitis and associated increased intracranial pressure, and were treated with an Ommaya reservoir. Both patients experienced rapid reversal of symptoms. At the time of discharge both patients had recovered and have remained asymptomatic.