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。     

可调压式分流管治疗脑积水

目的探讨使用可调压式分流管行脑室-腹腔分流术治疗脑积水的临床效果。方法采用可调压式分流管行脑室.腹腔分流术治疗脑积水18例。其中高压性脑积水6例;等压性脑积水10例;等压性脑积水伴穿通畸形2例。术前根据患者头颅CT及MRI提示脑积水类型设定阀门压力,术中测量颅内压并根据分流管末端滴速重新调整阀门压力。术后一周复查头颅CT了解脑积水缓解情况。出院后随访1-11月,根据头颅CT所示脑积水缓解情况再行阀门压力调整。结果脑积水症状缓解16例(88.9%);症状缓解不满意2例(11.1%)。18例均无出血、颅内感染及死亡。结论使用可调压式分流管行脑室一腹腔分流术,可在术前、术中、术后调整阀门压力,缓解脑积水症状,分流效果优于传统不可调压式分流管。     

侧脑室-腹腔分流术治疗正常压力脑积水28例

目的 探讨正常压力脑积水的手术治疗.方法 采用中、低压分流管行侧脑室-腹腔分流术.结果 本组28例,术后均得到6个月～3年随访,18例患者恢复正常生活,8例患者生活自理,2例患者术后症状无明显改善.结论 侧脑室-腹腔分流术是治疗正常压力脑积水最有效的方法.     

侧脑室-腹腔分流术治疗正常压力脑积水28例

目的 探讨正常压力脑积水的手术治疗。方法 采用中、低压分流管行侧脑室-腹腔分流术。结果 本组28例，术后均得到6个月～3年随访，18例患者恢复正常生活，8例患者生活自理，2例患者术后症状无明显改善。结论 侧脑室-腹腔分流术是治疗正常压力脑积水最有效的方法。     

Intraparenchymal Pericatheter Cyst as a Complication of a Ventriculo-Peritoneal Shunt in a Premature Infant

A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.     

动脉瘤性蛛网膜下腔出血后慢性脑积水的诊治

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积水的诊断与治疗方法。方法回顾性分析33例经手术治疗的aSAH后慢性脑积水患者的临床资料。结果治疗后随访6月～2年,按GOS评分,恢复良好27例,轻残3例,重残2例,死亡1例。结论慢性脑积水是aSAH后的常见并发症,脑室-腹腔分流术是aSAH后慢性脑积水的有效治疗方法。     

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...     

同期颅骨修补和脑室-腹腔分流治疗颅脑损伤后颅骨缺损合并脑积水

目的探讨早期一次性颅骨修补术及脑室-腹腔分流术对颅脑损伤后颅骨缺损合并脑积水中的治疗效果。方法回顾分析2003年1月至2008年10月同期进行颅骨修补及脑室-腹腔分流治疗的颅脑损伤后颅骨缺损合并脑积水患者34例的临床资料。本组手术时机均在伤后96d以内。结果术后意识及神经功能障碍不同程度改善30例（88．2％）；无明显变化4例。术后并发分流管梗阻1例，颅内感染2例。恢复良好18例（52．9％，18，34），中残8例（23．5％，8／34），重残或植物生存8例（23．5％，8，34），无手术死亡病例。结论颅脑损伤术后颅骨缺损、脑膨出、脑积水严重影响患者的预后，早期或同期行颅骨修补及脑室－腹腔分流术并发症少，且可明显减少患者的意识及神经功能障碍。     

Sub-galeal coiling of the proximal and distal components of a ventriculo-peritoneal shunt An unusual complication and proposed mechanism

We describe the case of a child in whom proximal migration of the peritoneal catheter and extrusion of the ventricular catheter resulted in the entire ventriculo-peritoneal shunt along with the shunt chamber (Orbis Sigma II valve) lying in a sub-galeal pocket in the occipital region in a tightly coiled fashion. This coiling was very similar in appearance to that of the pre-insertion shunt in the packaging when it is supplied; hence it is postulated that the migration was secondary to retained ’memory’ of the shunt tubing. This is a rare complication of ventriculo-peritoneal shunt, which has not been described before. Received: 8 March 1999     

两期脑室-腹腔分流术治疗急性脑积水和脑室积血的体会

目的 探讨对于脑脊液中含血量较多的急性脑积水、脑室内积血患者,分两期行脑室-腹腔分流术的手术治疗效果.方法 回顾分析10例经侧脑室置管外引流、腰大池置管外引流后脑积水不缓解,且两周后脑脊液中蛋白≥0.5 g/L的患者经先后两期脑室-腹腔分流术（一期金属管芯相连,二期置入分流阀）的手术治疗过程.结果 10例患者中8例患者效果良好,1例腹腔段出现堵管后再次手术,另1例发生术后颅内少量出血,经处理后好转.结论 对于脑脊液内含血较多的慢性脑积水患者,行两期脑室-腹腔分流术治疗,减少堵管及感染的发生,方法简便.     

腹腔镜辅助下治疗脑积水

目的探讨比较腹腔镜辅助下的脑室-腹腔(V-P)分流术与传统文献报道的V-P分流术的手术疗效。方法本组23例，梗阻性脑积水16例，交通性脑积水7例。19例颅内压高于正常。均行V-P分流术。将分流管的脑室端置入侧脑室的额角，分流泵置于耳后。腹腔端置管时，在腹腔镜的辅助下，于剑突下进入腹腔，并用一穿刺针带7号丝线，在右腋中、腋后线第八肋间刺入腹腔，将7号丝线带入腹腔，并固定于肝膈面。结果23例均行随访3～35个月．平均18个月。术后1周、1个月及3个月行头颅CT检查，脑室缩小至正常20例，2例好转，1例引流过度呈裂隙状。行腹部X线平片检查，所有病例引流管均在肝膈面。23例均无引流管阻塞发生，无颅内感染及腹腔感染。4例脑肿瘤患者术后9～13月死亡。结论腹腔镜辅助下的侧脑室-肝隔间隙分流术治疗脑积水，与传统的常规V-P分流术比较，具有切口小、创伤轻、恢复快的特点，人工气腹使肝隔间隙显露良好、视野大而开阔、手术操作空问大、使分流管末端粘连及阻塞的可能性明显减少。     

正常压力脑积水的临床特征和手术治疗

目的探讨正常压力脑积水(NPH)的临床特征和手术治疗效果。方法 NPH患者32例,其中17例应用中压分流管、15例用可调压分流管行脑室-腹腔分流术治疗。结果应用可调压分流管分流者的症状改善率为86.7%(13/15),应用中压分流管者为41.2%(7/17),两者相差显著(P<0.01)。结论应用可调压分流管行脑室-腹腔分流是治疗NPH的有效方法。     

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.     

脑室-腹腔分流术治疗结核性脑膜炎并发脑积水

目的探讨脑室-腹腔分流术(VPS)治疗结核性脑膜炎(TBM)合并脑积水的效果。方法回顾性分析2004年1月至2010年7月行VPS治疗的15例TBM合并脑积水患者的临床资料。结果 15例患者全部行VPS,术后意识均好转、症状减轻,未发生结核性腹莫炎。术前抗结核治疗1月以上者10例,均无分流管堵塞发生;而另外5例抗结核治疗不足1月者,分流管堵塞者2例。脑脊液蛋白含量在0.5g/L以上者6例中2例堵管;脑脊液蛋白在0.5g/L以下的9例中,无堵管者。结论 VPS是治疗TBM并发脑积水的有效方法,术前最好能抗结核治疗1月以上。     

Persistent hydrocephalus due to postural activation of a ventricular shunt anti-gravity device

The ever present need to balance over drainage with under drainage in hydrocephalus has required innovations including adjustable valves with antigravity devices. These are activated in the vertical position to prevent siphoning. We describe a group of bedridden patients who presented with unexplained under drainage caused by activation of antigravity shunt components produced by peculiar head/body position.Retrospective single centre case series of hydrocephalus patients, treated with ventriculo-peritoneal (VP) shunt insertion between April 2014 – February 2016. These patients presented with clinical and radiological under drainage syndrome. Medical notes were reviewed for clinical picture and outcome. Radiological studies were reviewed assessing shunt placement and ventricular size.Seven patients presented with clinical and radiological under drainage syndrome. A consistent posturing of long term hyper-flexion of the neck whilst lying supine was observed. All patients had similar shunt construct (adjustable Miethke ProGAV valve and shunt assistant anti-gravity component). In each of those patients a hypothesis was formulated that neck flexion was activating the shunt assistance anti-gravity component in supine position. Five patients underwent shunt revision surgery removing the shunt assistant device from the cranium and adding an anti-gravity component to the shunt system at the chest. One had the shunt assistant completely removed and one patient was managed conservatively with mobilisation. All patients had clinical and radiological improvement.Antigravity shunt components implanted cranially in bedridden hydrocephalus patients will produce underdrainage due to head flexion induced anti-gravity device activation. In these patients, anti-gravity devices should be placed at the chest. Alternatively, special nursing attention should be paid to head-trunk angle.     

The diagnostic importance of eosinophil granulocytes in the CSF of children with ventricular-peritoneal shunt systems

We investigated the occurrence of cerebrospinal fluid (CSF) eosinophilia in patients with ventriculo-abdominal shunt systems with regard to possible infection. For this purpose, we examined the CSF of 83 children at the time of shunt obstruction or malfunction. In 32 children (38.6%) we found more than 4% of eosinophil granulocytes in the CSF with a maximum of 76%. In 15 of these 32 children the CSF was sterile, whereas in 17 patients bacterial infection was present. In the CSF of 16 of those 17 children, Staph. epidermidis was cultivated. There was statistically significant correlation between positive Staph. epidermidis culture and the occurrence of CSF eosinophilia ( P < 0.05). The occurrence of CSF eosinophilia in patients with ventriculo-peritoneal shunts is well known and was mostly attributed to an allergic reaction. Our findings support the theory of an infectious etiology of the eosinophilia and are thus in line with new American and French studies. We believe that CSF eosinophilia indicates a persistent infection of the central nervous system by the contaminated shunt system. As the organism which is the most common cause we cultured Staph. epidermidis .     

How should primary aqueductal stenosis in adults be treated? – A review

In 10% of adult patients with hydrocephalus, the cause is because of aqueductal stenosis (AS), causing enlargement of the lateral and third ventricles. There are currently two alternate forms of surgical treatment for AS; shunt surgery and ventriculostomy. Shunt surgery is associated with high complication rates and many patients need revisions, but the effectiveness is high. Endoscopic third ventriculostomy (ETV), re-establishing a physiological route of CSF dynamics, has become the treatment of choice for AS in most neurosurgical centers. ETV has fewer complications and revisions are rare, but some patients need shunt surgery to improve despite a patent ventriculostomy. There are today no common criteria for patient selection to either ETV or ventriculo-peritoneal shunt surgery.     

Growth of basilar artery aneurysm after ventriculo-peritoneal shunt

We report upon two cases of obstructive hydrocephalus produced by giant basilar artery aneurysms. They initially presented with symptoms of increased intracranial pressure, and were managed by a ventriculo-peritoneal (VP) shunt with good symptomatic improvement. With time, however, both showed a gradual deterioration of clinical symptoms due to increased aneurysm size. One, with a basilar tip aneurysm was treated by direct neck-clipping of the aneurysm, and was able to return to work. In the other patient, with a basilar trunk aneurysm, endovascular occlusion of one vertebral artery was attempted in an effort to decrease the aneurysm size, but the aneurysm enlarged precipitating brain stem failure. In conclusion, these cases reveal the risk of the VP shunt, which may induce aneurysmal growth, leading to clinical devastation, and emphasize the importance of definitive treatment for giant cerebral aneurysms whenever possible.     

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。     

早期颅骨修补及脑室腹腔分流在脑外伤治疗中的作用

目的探讨早期一次性颅骨修补及脑室腹腔分流在脑外伤治疗中的作用。方法回顾性分析2003年1月至2005年12月同期行颅骨修补及脑室腹腔分流的脑外伤病例34例,对其临床资料、并发症及预后进行总结。结果本组手术时机均在伤后3个月以内,术后并发分流管阻塞1例,颅内感染2例;术后意识及神经功能障碍不同程度改善30例(88%);恢复良好18例(53%),中残8例(24%),无手术死亡病例。结论颅脑损伤术后颅骨缺损、脑膨出、脑积水严重影响患者预后,早期并同期行颅骨修补及脑室腹腔分流术并发症少,可明显缓解患者意识及神经功能障碍,提高患者预后,值得临床进一步推广。