可调压分流管治疗颅内静脉异常回流所致高颅压性脑积水

目的 探讨磁共振相位电影对比成像法在内镜下导水管成形术治疗导水管梗阻性脑积水的应用价值.方法 对23例诊断为导水管梗阻性脑积水的患者,术前常规采用磁共振相位电影对比法进一步确诊;手术采用电子软性神经内镜下导水管成形术,术中对导水管阻塞程度进行评估.术后1周及随访均采用磁共振相位电影对比法复查来测量导水管脑脊液流速流量以确定导水管是否开通.结果 23例术前磁共振相位电影对比法未见导水管脑脊液流动患者,术中见导水管完全闭塞或直径小于1 mm2;23例患者成形术均获成功,导水管扩张平均在4 mm左右,术后1周电影成像检查导水管平均流速为(4.74±1.77)cm/s,在随访期间,2例再次出现颅高压症状的患者,电影成像显示导水管未见脑脊液流动,二次内镜下探查见导水管重新闭塞.结论 磁共振相位电影对比法通过测量导水管内脑脊液流速流量来精确判断导水管开通情况,可以作为导水管梗阻性脑积水术前诊断及导水管成形术后疗效判断及随访的重要工具.

Abstract：

Objective To evaluate the application of phase-contrast cine magnetic resonance imaging (MRI) in endoscopic aqueductoplasty for patients with obstructive hydrocephalus. Methods The clinical diagnosis of hydrocephalus due to aqueduct obstruction in 23 patients was confirmed by phasecontrast cine MRI examination. The patients were treated with endoscopic aqueductoplasty. MRI was repeated during follow- up period. The cerebrospinal fluid (CSF) flow velocity in aqueduct was measured to determine whether the aqueduct was obstructed. Results The Results of phase -contrast cine MRI examinations indicated that there was no CSF flow in aqueduct in any patient. Aqueductoplasty was successfully performed in all patients. After one week, the Results of phase - contrast cine MRI examinations showed an average CSF flow velocity of (4.74 ± 1.77) cm/s. During follow - up period, intracranial hypertension recurred in two patients in whom CSF flow was not seen inside the aqueduct by phase - contrast cine MRI scan and the aqueduct re - occlusion was revealed by endoscopic exploration. Conclusions By measuring CSF flow velocity, phase - contrast cine MRI could accurately identify whether the aqueduct is obstructed. It should play an important role in the diagnosis of obstructive hydrocephalus and evaluation of theeffectiveness of aqueductoplasty, and it could be used for follow - up evaluation as well.

Pressure-adjustable shunt in treatment of hydrocephalus associated with congenital intracranial anomalous venous return

Objective To investigate the value of Codman Hakim pressure - adjustable shunt in the treatment of hydrocephalus associated with congenital intracranial anomalous venous return. Methods 2patients whose diagnosis were confirmed by CT,MRI, MRV and DSA and programmable ventriculoperitoneal shunting was given. Results The pressure of 2 cases of patients undergoing shunt valve was set to 200mmH2O in operation and the pressure was reduce gradually. The patients developed symptoms of low intracranial pressure in different degrees when the pressure was reduced to 180 mmH2O. The symptoms were alleviated after the pressure was increased. The mental and motor function of 2 patients were improved significantly and CT examinations showed decreased ventricles. Conclusious The hydrocephalus associated with congenital intracranial anomalous venous return is rare and the treatment experience is not enough. Pressure-adjustable shunting is the best treatment for this kind of hydrocephalus. The pressure should be adjusted several times for a long time to achieve a suitable individual pressure gradually.