腹腔镜下脑室-腹腔分流术治疗小儿脑积水的疗效观察

目的探讨腹腔镜下脑室-腹腔分流术治疗小儿脑积水的临床效果。方法回顾性分析我院神经外科2012-03-2013-04收治的68例脑积水患儿的临床资料,根据手术方式分为实验组（37例）和对照组（31例）,实验组行腹腔镜下脑室-腹腔分流术,对照组采用传统脑室-腹腔分流术。观察2组患者手术情况及术后随访情况。结果对照组手术时间、术后排气时间均明显长于实验组（P＜0.05）;2组手术前后双侧脑室额角差值差异无统计学意义（P＞0.05）;术后3个月2组总有效率差异无统计学意义（P＞0.05）;2组Kamofsky评分同期比较差异无统计学意义（P＞0.05）,2组术后Kamofsky评分较术前显著升高（ P＜0.05）;术后对照组分流管梗阻（22.58％）、腹腔感染（19.36％）发生率均显著高于实验组（5.14％、2.70％,P＜0.05）。结论腹腔镜下脑室-腹腔分流术治疗小儿脑积水具有手术过程短、患者恢复快、术后并发症少等优点,且疗效可靠,值得临床推广。     

脑积水脑室-腹腔分流术后分流系统梗阻的原因及防治

目的讨论脑积水经脑室-腹腔分流术后分流系统梗阻的原因及其防治方法。方法回顾性分析2006年1月至2012年1月53例脑积水脑室一腹腔分流术治疗分流系统梗阻患者的临床资料。结果脑室端梗阻27例,分流泵和储液囊梗阻7例,颈、胸、腹段引流管梗阻4例,腹腔端梗阻15例。53例患者经调整或更换分流系统后脑室系统较术前缩小,48例恢复良好,1例因严重感染死亡,1例术后即转回当地医院康复,3例再发梗阻调整后好转。结论规范的手术操作、良好的无菌观念、及时的健康教育是预防分流系统梗阻的关键。     

Unusual proximal migration of ventriculoperitoneal shunt into the heart

Quite a number of cases of upward shunt migration have already been reported in the literature. In this paper, the intracardiac migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by a plain radiograph of the chest and a direct open heart surgery. To the author's knowledge this is the first reported case of migration of a peritoneal shunt tube into the heart. The authors postulate possible mechanisms and a physioanatomical explanation on the basis of the surgical findings.     

脑室-腹腔分流管移位至心脏二例报告及文献复习

目的 探讨罕见的脑室-腹腔分流管移位至心脏的发病机制、临床特点、诊治方法及并发症.方法 分析2例脑室-腹腔分流管移位至心脏的诊治过程,并结合文献对本病的预防及诊治进行讨论.结果 通过临床表现及影像学检查明确诊断,手术顺利拔除了移位的分流管,术中及术后患者病情平稳.结论 首次在国内报道了脑室-腹腔分流管移位至心脏的病例;在脑室-腹腔分流术中注意通条打皮下隧道时不宜过深或过浅,通条头部不宜过尖;术后出现异常应复查头部CT、胸片及腹片;直接从头部原切口处切开拔除分流管是简单、可行、安全的手术方式.

Abstract：

Objective To discuss the mechanism, clinical features, complications, diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Method The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of ventriculoperitoneal shunt were studied, and relative literatures were reviewed. Results The migratory catheter was successfully extracted after definite diagnosis according to clinical features and imaging findings. There was no postoperative abnormality. Conclusions This is the first report of migration of the distal catheter of ventriculoperitoneal shunt into heart in China.The possible measures to minimize the incidence of the migration include avoiding deep or superficial neck tunneling and using blunt tunneling devices. Head CT, chest and abdominal x - ray are needed if postoperative abnormality is noticed. Percutaneous removal of the catheter from the retroauricular fomer incision is simple and safe.     

交通性脑积水脑室-腹腔分流术后迟发性颅内出血发生风险的列线图预测模型构建与评估

目的探讨交通性脑积水（CHP）脑室-腹腔分流（VPS）术后迟发性颅内出血（DICH）发生的危险因素,构建预测术后DICH发生的列线图模型,并对模型的预测效果予以评估。 方法选取淮安市第二人民医院神经外科自2016年2月至2021年8月行VPS术的307例CHP患者为研究对象进行病例对照研究,根据术后是否发生DICH分为DICH组（49例）和对照组（258例）。收集所有患者的基本资料（包括年龄、性别、原发病、是否合并基础疾病、既往颅脑手术史、抗凝药使用史、有无颅骨缺损等）及治疗信息（穿刺侧别、1周内调节分流阀门）行单因素分析,通过多因素Logistic回归分析确定术后CHP的危险因素,并通过受试者工作特征（ROC）曲线和校准曲线评估列线图模型的预测能力。另选取104例行VPS术的CHP患者为验证集,并对列线图模型做外部验证。 结果DICH组年龄、既往颅脑手术史比例、颅骨缺损比例、1周内调节分流阀门比例明显较对照组高（P<0.05）;Logistic回归分析结果显示,年龄、既往颅脑手术史、颅骨缺损、1周内调节分流阀门是CHP患者VPS术后DICH发生的主要危险因素（P<0.05）;ROC曲线分析结果显示,构建的CHP患者VPS术后DICH发生的列线图预测模型具有较好的区分度[曲线下面积（AUC）为0.858,95%CI：0.804~0.913]和精准度（拟合优度HL检验χ²=7.831,P=0.396）;104例行VPS术的CHP患者中16例发生DICH,发生率为15.38%,外部验证中AUC为0.792（95%CI：0.729~0.855）,校准曲线拟合优度HL检验（χ²=8.319,P=0.351）,提示精准度较高。 结论基于年龄、既往颅脑手术史、颅骨缺损、1周内调节分流阀门4项危险因素构建的CHP患者VPS术后DICH发生的列线图模型具有较高的预测效能。     

Ultrasound for the assessment of distal shunt malfunction in adults with internal ventricular shunts

Shunts that are used for the treatment of hydrocephalus have a propensity towards malfunction, however, diagnosing a shunt malfunction can sometimes be a challenge. The purpose of this study was to investigate whether ultrasound technology can be safely and effectively used to assess for distal shunt malfunction. This was a prospective cohort study at a single institution. Eighteen adult patients that received a radionuclide shunt patency study also underwent an ultrasound shunt patency study. Ultrasound with Doppler technology was used to visualize flow through the shunt tubing following manual compression of the shunt reservoir. A peak flow speed was recorded and the results were compared to the results of the radionuclide shunt patency study. A Receiver Operating Characteristic (ROC) curve comparing the ultrasound to the radionuclide shunt patency study was generated, revealing an Area Under the Curve (AUC) of 0.95 (95% CI: 0.84–1.00). The ultrasound test performed maximally with a cutoff speed of ≤10 cm/s as the criteria for malfunction, with a sensitivity of 100.00%, specificity of 90.91%, accuracy of 94.44%, positive likelihood ratio of 11.000 and negative likelihood ratio of 0.000 using the radionuclide study results as criteria for comparison. Overall, ultrasound has the potential to be a safe, quick, available and cost-effective screening test for patients with suspected distal shunt malfunction. The high sensitivity of the test makes it an attractive option for use as a screening method that could potentially reduce the number of cases requiring radionuclide shunt patency study.     

An unusual complication of ventriculoperitoneal shunt with bladder perforation and extrusion through the urethra orifice in an adult male patient

A 29-year-old male exhibited progressive extrusion of the distal end of ventriculoperitoneal (VP) shunt through his urethral orifice within 10 d. The distal end of VP shunt was pulled out from the urethral orifice without bladder repairment, a new VP shunt assisted with ventriculoscope and laparoscope was performed and the distal end of VP shunt was fixd to the suprahepatic space. We first report a chronic complication of VP shunt with bladder perforation and extrusion through the urethral orifice in an adult male patient. To avoid this complication, the length of the distal end of VP shunt should be kept as short as possible in adults and we recommend that the distal end of VP shunt should be fixed to the suprahepatic space assisted with laparoscope in adult patients.     

Acute cholecystitis complicating ventriculo-peritoneal shunting: report of a case and review of the literature

Case A 3-year-old boy underwent emergency external ventricular drainage and excision of a fourth ventricle anaplastic ependymoma. A week later, the child was given a ventriculo-peritoneal shunt. Fourteen days after shunting, the child developed a subphrenic abscess and acute cholecystitis that required surgery. Results A Staphylococcus epidermidis was isolated both from the ventricular catheter and CSF and from the subphrenic abscess and the gallbladder. To our knowledge, this is the first report of cholecystitis evolving as a descending shunt infection. The current literature related with this unique complication is briefly reviewed.     

Radiation-induced tumors of the central nervous system occurring in childhood and adolescence Four unusual lesions in three patients and a review of the literature

The authors report four very rare radiation-associated tumors (or radiation-induced tumors; RITs) of the central nervous system (CNS) and review the literature on this topic. The purpose of this study was to determine the possible relationship between the harmful effects of radiation therapy, the shortest and the longest interval between the time of irradiation and the occurrence of the secondary tumor, and possible predisposing factors. The tumorigenic effects of therapeutic irradiation of the CNS have been mentioned in the literature, but the authors’ literature search did not disclose either many reports of cases such as their own or a satisfactory and concise discussion on the different aspects of the late and catastrophic complications of this method of adjunct therapy to the CNS. Four rare cases of RIT in three patients are presented: a unique case of intradural meningioma of the cervical spine, which was irradiated successfully only for the patient to present with a new high-grade cerebral astrocytoma 4 years later, a paraventricular cavernoma and a fronto-temporo-orbital chondrosarcoma. These second RITs became symptomatic in the 17th, 16th and 15th years of life, respectively, in these young patients. The primary lesions were ependymomas, two in the IV ventricle and one in the left hemisphere. The time intervals between radiation and secondary tumor presentation were 14 and 18 years, 9 years and 28 months, in the order in which these patients presented. All the patients survived the second operation except the one with chondrosarcoma, who died in spite of repeated surgical interventions and adjunct therapies. It is concluded that the development of secondary RITs does not necessarily require a very long time interval; that although sarcomas are the most common RITs of the CNS in childhood and adolescence, benign and other rare and curable lesions may also occur in the field or vicinity of the field of radiation; and that in view of the possibility of occurrence of different types of RITs after varying time intervals in a single patient, whole-life follow-up of similar patients is mandatory. Received: 7 December 1998 Revised: 12 March 1999     

Aneurysm of the posterior inferior cerebellar artery caused by a traumatic perforating artery tear-out mechanism in a child

Traumatic posterior circulation aneurysms in the absence of fractures and penetrating wounds are extremely uncommon, especially in children. To our knowledge this is the first traumatic posterior inferior cerebellar artery(PICA) aneurysm reported that cannot be related to a skull fracture or a trauma caused by the edge of a rigid meningeal structure. In the present case, the initial subarachnoid hemorrhage (SAH) was caused by a perforating artery, originating from the PICA, which was torn out as the result of a deceleration trauma. Such a mechanism explains both the initial SAH and the development of the false aneurysm responsible for the second SAH. Received: 20 January 1999     

The effect of mosapride citrate on proximal and distal colonic motor function in the guinea-pig in vitro.

Mosapride citrate (mosapride), a substituted benzamide, is a selective 5-HT(4) receptor agonist, and is known to have prokinetic properties on the stomach. However, it is unclear whether mosapride also has a prokinetic effect on the colon. We previously found that mosapride significantly shortened colonic transit time in the guinea-pig, an animal with a distribution of colonic 5-HT(4) receptors similar to that of a human. So, we aimed to separately evaluate the effect of mosapride on proximal and distal colonic motor function in the guinea-pig. Proximal (approximately 8 cm from the ileocolic junction) and distal colon (approximately 8 cm from the anus) were removed. Both ends of the colon were connected to a chamber containing a Krebs-Henseleit solution. To measure colonic transit time, artificial faeces were inserted into the oral side of the lumen and moved towards the anal side by intraluminal perfusion via a peristaltic pump. A total of 6 cm of transit was observed and time was measured in 2 cm increments. A tissue bath study, using electrical stimulation, was performed to estimate the contractile activity of the circular musculature of the colon. Immunohistochemical staining for 5-HT(4) receptors was performed in the myenteric plexus and circular muscle in both proximal and distal colon, and the stained area was measured using a microscope and computer software. Mosapride enhanced contraction at 10(-9) to 10(-7) mol L(-1), coinciding with rapid transit both in proximal and distal colon. This pattern was more prominent in proximal colon. At the high dose (10(-6) mol L(-1)) mosapride had little or no effect on colonic contraction. This stimulatory effect was attenuated by GR113808, atropine and tetrodotoxin. In the myenteric plexus, the density of 5-HT(4) receptors was significantly greater in the proximal colon than in the distal colon, but in circular muscle the density was greater in the distal colon. Thus, mosapride accelerates transit through increased contraction in the proximal colon more than distal colon. The different distribution of neuronal and muscular 5-HT(4) receptors may support these findings. Therefore, mosapride may be a useful alternative to tegaserod and cisapride for constipation.     

Ultrasound-guided puncture of a Dandy-Walker cyst via the lateral and III ventricles

Since the Dandy-Walker syndrome was first described by Dandy and Blackfan, Taggart and Walker, the many variants of posterior fossa anomalies, the appropriate management of these malformations and the clinical outcome have been the subjects of controversy. Surgery of the posterior fossa with membrane excision was initially the preferred method of treatment. Unfortunately, there was a high rate of complications, and many of the patients treated in this way still needed a shunting system. Ventricular-peritoneal and/or cysto-peritoneal shunting is commonly used to treat symptomatic posterior fossa cysts of Dandy-Walker malformations and hydrocephalus. Cysto-peritoneal shunt implantation only was associated with a high rate of complications, and most patients so treated needed a ventriculo-peritoneal shunt in addition. According to the literature, combined ventriculo-peritoneal and cysto-peritoneal shunting is needed for satisfactory decompression of Dandy-Walker cyst and hydrocephalus in between 16% and 92% of cases. We report on a young patient with a Dandy-Walker malformation who needed drainage of the posterior fossa and a ventricular shunt. We decided to drain the cyst and the supratentorial ventricles via a single, especially prepared, catheter with many perforations. The catheter was inserted under ultrasound guidance. The tube was inserted from the left lateral ventricle through the foramen of Monro into the III ventricle and downwards into the cyst. Intraoperatively, an immediate decrease in the size of the cyst and the supratentorial ventricles was observed. Postoperative MRI confirmed the exact position of the catheter and sufficient drainage of the posterior fossa cyst and the ventricles. Six months later the girl was seen in our outpatient department. Clinical examination showed no neurological deficit, and MRI demonstrated sufficient drainage of the ventricles and the Dandy-Walker malformation, and in addition hypoplasia of the corpus callosum. Received: 31 March 1999     

Rapidly enlarging dermoid cyst over the anterior fontanel: a case report and review of the literature

A case report of a rapidly enlarging dermoid cyst over the anterior fontanel is presented. Our presentation demonstrates the course of rapid enlargement of the tumor with radiological images, which were examined at birth and during the process of the tumor enlargement. The literature is reviewed with respect to the nature of this tumor, especially to the relationship of tumor enlargement. Received: 1 November 1999     

Fine localization of the CMT4A locus using a PAC contig and haplotype analysis

Charcot-Marie-Tooth disease type 4A (CMT4A) is a severe, autosomal recessive peripheral neuropathy linked to chromosome 8q13-q21. We have previously constructed a YAC contig across the CMT4A region and narrowed the disease-flanking interval to approximately three megabases. Subsequently, we constructed a PAC/BAC contig made of 44 clones and mapped 44 new and 30 previous STSs, ESTs, and polymorphic makers to the region. Using 13 polymorphic markers, we have now identified an ancestral haplotype segregating in three families, indicating a common founder mutation. Two ancestral recombination events in this haplotype significantly reduce the minimal candidate region to a minimal trailing path of five PAC/BAC clones, which will now allow direct investigation of candidate genes for CMT4A. Received: April 8, 1998 / Accepted: June 15, 1998 / Published online: October 28, 1998     

Cloverleaf skull and multiple congenital anomalies in a girl exposed to cocaine in utero: case report and review of the literature

The case of a girl with cloverleaf skull (CLS) and multiple congenital anomalies is reported. Both parents have a history of drug use. Maternal cocaine abuse during the first trimester of pregnancy was obvious, and other drugs, such as marihuana and alcohol, were also taken by the mother. Many central nervous system malformations have been reported in association with cocaine abuse, the most severe being midline defects and neural tube defects. To our knowledge this is the first case reported of CLS anomaly associated with drug exposure. We also describe other anomalies not previously reported in association with CLS. Received: 28 May 1998