脑室-腹腔分流术治疗外伤性正常压力性脑积水的疗效

目的探讨脑室-腹腔分流术(V-P分流术)治疗外伤性正常压力性脑积水的效果。方法回顾性分析48例外伤性正常压力性脑积水病人的临床资料,根据术前临床症状分为典型症状组和不典型症状组,均行V-P分流术,其中行去骨瓣减压术22例。并评估分流术后病情及预后情况。结果随访12个月,根据GOS评分,术后恢复良好12例,轻度残疾23例,重度残疾8例,植物生存3例,死亡2例。根据电话及门诊随访,病情改善41例(85.4%),病情无明显好转甚至恶化7例;其中典型症状组病情改善率100%,不典型症状组病情改善率72%。影像学检查提示:分流术后所有病人脑室均有不同程度缩小。22例行去骨瓣减压术的病人,分流术后6个月内均顺利行颅骨修补术,术后病情均明显改善。结论对外伤性正常压力性脑积水病人,把握好手术适应证,即使无典型临床症状,行V-P分流术后,大部分病人预后可获得改善。

Therapeutic effect of ventriculo-peritoneal shunt for posttraumatic normal pressure hydrocephalus

Objective To investigate the efficacy of ventriculo-peritoneal （V-P） shunt in treating posttraumatic normal pressure hydrocephalus （PNPH）. Methods Clinical data of 48 PNPH patients were analyzed retrospectively. The patients were divided into typical symptom group and atypical symptom group according to preoperative clinical symptoms. All the patients received V-P shunt, and 22 out of them received additional decompressive craniectomy. The clinical condition and prognosis were evaluated after V-P shunt. Results During a follow-up of 12 months, good recovery was achieved in 12 cases, and mild disability resulted in 23, severe disability in 8, vegetative state in 3 and death in 2 according to GOS scores. The clinical symptoms improved in 41 cases （85.4%） and not obviously changed or even aggravated in 7, while the improvement rate of clinical condition was 100% in typical symptom group and 72% in atypical symptom group by follow-up though telephones and/or outpatient visits. The cerebral ventricle shrunk to different extents after V-P shunt in all the patients by imaging examination. In 22 patients undergoing decompressive craniectomy, the cranioplasty was smoothly performed in 6 months after V-P shunt, and the clinical condition of patients all improved obviously. Conclusions If only the doctors grasp the surgical indication well, even if the patient has no typical symptoms, the prognosis can be improved by V-P shunt in most PNPH patients.