影响多排螺旋CT显示肝癌APS影像征象的因素分析

目的:研究肝癌APS的16层螺旋CT表现,分析影响16排螺旋CT显示肝癌APS影像征象的因素。方法:分析175例肝癌患者的16层螺旋CT扫描影像表现,对16层螺旋CT双期扫描显示的肿瘤大小、肿瘤位置、有无癌栓、分流位置等征象进行Logistic回归分析。结果:门静脉癌栓的相对危险度为1.05,肿瘤位置的相对危险度为1.60。其他相关征象在本研究中不是16排螺旋CT相关的肝癌APS显示影响因素。结论:影响16排螺旋CT显示肝癌APS影像征象的因素分别为门脉癌栓和肿瘤位置。     

Shunt in high-risk newborns

Twenty-four high-risk newborns with a low birth weight developed progressive hydrocephalus and underwent ventriculoperitoneal shunting (at the time of shunting they weighed 1,100–1,990 g, mean 1,541.5 g). The changes in hydrocephalus after shunting were determined by ultrasound examinations; preoperative examination was by CT. Of the factors evaluated for their relationship to shunt complication, we considered in particular babies with a CSF protein level of over 1.5 g/l (7 cases). These cases were treated with external drainage and later with ventriculoperitoneal shunting. Shunt infections occurred in 20.9%, in contrast with a low incidence of shunt blockage (8.3%), probably owing to previous external shunting in children with high CSF protein. There were 2 deaths (8.3%). All children underwent careful follow-up during the 1st year and serial checkups subsequently for 5 years.     

Post-traumatic hydrocephalus is a contraindication for endoscopic third-ventriculostomy: Isn’t it?

Objectives

Post-traumatic hydrocephalus (PTH) is commonly considered as a relative contraindication for endoscopic third-ventriculostomy (ETV). However, few studies are available on this topic.

Methods

An analysis of the papers published in the last ten years has been performed, in order to assess the level of evidence on which the current indication for ETV for PTH is based.References were identified by PubMed searches of clinical articles relating to both PTH and ETV. Laboratory investigations were excluded.

Results

Only 5 articles were selected, for a total of 15 patients with PTH treated with ETV. All these patients were described by the authors to have a communicating hydrocephalus. No complications of surgery were reported.Outcome data were not available for one patient. Thirteen out of the remaining 14 patients had a clinical improvement after the surgical procedure (93%). Direct or indirect information on pre-operative ICP was available for 11 cases. Eight of them had an elevated ICP and presented a clinical improvement after ETV.

Conclusions

There is no current evidence to support that PTH is a contraindication for ETV. Our data suggest that we could reconsider ETV for the treatment of PTH, especially for patients with elevated ICP. Prospective clinical trials (involving several centers, due to the difficulty of recruiting patients with PTH) are needed.     

The Role of Lumbar Drainage to Prevent Shunt-Dependent Hydrocephalus after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage in Good-Grade Patients

Objective

To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients.

Methods

One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms.

Results

One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure.

Conclusion

Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.     

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Objective

This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure.

Methods

We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage.

Results

At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series.

Conclusion

The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.     

颅内蛛网膜囊肿-腹腔分流术后疗效长期随访分析

目的 探讨囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿的疗效.方法 回顾我院2003年1月至2005年1月62例囊肿分流手术治疗颅内蛛网膜囊肿患者,随访其CT及MRI结果,对其疗效进行了长期随访.结果 62例囊肿中46例(74％)位于侧裂,8例(13％)位于大脑凸面,8例(13％)位于幕下.所有患者接受了蛛网膜囊肿-腹腔分流术.术后平均随访时间6.5年(6-8年),59例患者影像资料显示囊肿大部消失或完全消失,占95％.与分流手术相关的并发症有16例,其中8例出现良性颅高压症状.结论 囊肿-腹腔分流术是一种简单有效、安全的治疗方法,但应严格选择其手术适应证,对术后可能的并发症也应予以充分的重视.     

The role of amyloid PET in patient selection for extra-ventricular shunt insertion for the treatment of idiopathic normal pressure hydrocephalus: A pooled analysis

BackgroundIdiopathic Normal Pressure Hydrocephalus (iNPH) can be effectively treated through shunt insertion. However, most shunted patients experience little or no clinical benefit, which suggests suboptimal patient selection. While contentious, multiple studies have reported poorer shunt outcomes associated with concomitant Alzheimer’s disease. Prompted by this observation, multiple studies have assessed the role of amyloid PET, a specific test for Alzheimer’s disease, in patient selection for shunting.MethodsA comprehensive literature search was performed to identify studies that assessed the association between amyloid PET result and the clinical response to shunting in patients with suspected iNPH. Pooled diagnostic statistics were calculated.ResultsAcross three relevant studies, a total of 38 patients with suspected iNPH underwent amyloid PET imaging and shunt insertion. Twenty-three patients had a positive clinical response to shunting. 18/28 (64.3%) of patients with a negative amyloid PET and 5/10 (50%) with a positive amyloid PET had a positive response to shunting. The pooled sensitivity, specificity and accuracy was 33.3%, 76.2% and 58.3%. None of these statistics reached statistical significance.ConclusionThe results of this pooled analysis do not support the selection of patients with suspected iNPH for shunting on the basis of amyloid PET alone. However, due to small cohort sizes and weakness in study design, further high-quality studies are required to properly determine the role of amyloid PET in assessing this complex patient group.