合并颅骨缺损的脑积水病人分流术后反常性脑疝的诊治分析  

Diagnosis and treatment of paradoxical herniation after cerebrospinal fluid shunt in patients with hydrocephalus associated with large skull defect

作　　者：王在贵 管江衡 徐国政 甘志强 宋健 WANG Zai-gui;GUAN Jiang-heng;XU Guo-zheng;GAN Zhi-qiang;SONG Jian(Department of Neurosurgery,General Hospital of Central Theater Command,Wuhan 430070,China)

机构地区：[1]中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2023年第6期365-368,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨合并大面积颅骨缺损的脑积水病人分流术后反常性脑疝的临床特征及诊治方案。方法回顾性分析2019年1月至2022年12月收治的8例合并大面积颅骨缺损的脑积水分病人的临床资料。结果8例均为交通性脑积水,其中高颅压性脑积水2例,正常压力或低压力性脑积水6例。8例均行脑室-腹腔分流术,分流管选择可调压分流阀+重力辅助阀/抗虹吸阀,术后2周内出现反常性脑疝,其中7例上调分流阀压力后反常性脑疝临床表现消失;1例上调分流阀压力至200 mmH2O仍存在反常性脑疝临床表现,行颅骨成形术后缓解。5例行颅骨成形术,术后下调分流阀压力。结论合并大面积颅骨缺损的脑积水,不恰当的分流阀初始压力设置可导致反常性脑疝,建议此类脑积水病人选择可调压分流阀+重力辅助阀/抗虹吸阀,因为通过上调分流阀压力可及时治疗反常性脑疝。颅骨成形为改善反常性脑疝病人预后的有效方法,同时成形术后应根据病人具体情况及时调整分流阀压力。Objective To investigate the clinical features,diagnosis and treatment of paradoxical herniation after cerebrospinal fluid shunt in patients with hydrocephalus associated with large skull defect.Methods The clinical data of 8 patients with hydrocephalus associated with large skull defect who were admitted to our hospital from January 2019 to December 2022 were retrospectively analyzed.Results All the patients suffered from communicating hydrocephalus,including 2 patients with high cranial pressure hydrocephalus and 6 with normal or low pressure hydrocephalus.All patients underwent ventriculoperitoneal shunt,and the adjustable pressure shunt valve+gravity auxiliary valve/anti-siphon valve were used in all the patients.Paradoxical herniation occurred in all the patients within 2 week after shunt.The clinical manifestations of paradoxical herniation disappeared after the shunt valve pressure was raised in 7 patients,and the clinical manifestations of paradoxical herniation were still present in 1 patient after the shunt valve pressure was raised to 200 mmH2O,which were relieved after cranioplasty.Five patients underwent cranioplasty,and the shunt valve pressure was reduced after operation.Conclusions In the patients with hydrocephalus associted with large skull defect undergoing cerebrospinal fluid shunt,improper initial pressure setting of the shunting valve may cause paradoxical herniation.The adjustable pressure shunting valve+gravity auxiliary valve/anti-siphon valve is recommended for these patients,because the paradoxical herniation can be treated in time by increasing the pressure of the shunting valve.Cranioplasty is an effective method to improve the prognoses of patients with paradoxical herniation,and the shunt valve pressure should be adjusted in time according to the specific conditions of patients.

关 键 词：反常性脑疝 大面积颅骨缺损 脑积水 分流术 颅骨成形术 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]