负压性脑积水的诊治5例分析及文献复习  

Diagnosis and treatment of negative pressure hydrocephalus: analysis of 5 cases and literature review

作　　者：孙涛 刘庆银 蒲珂[3] 韩国庆 李庆国[3] Tao Sun;Qingyin Liu;Ke Pu;Guoqing Han;Qingguo Li(Department of Neurosurgery,Xiqing Hospital Tianjin 300000;Department of Neurosurgery,Fei County People's Hospital,Shandong Province 273400;Department of Neurosurgery,Huanhu Hospital,Tianjin 300000)

机构地区：[1]天津市西青医院神经外科,天津300000 [2]山东省费县人民医院神经外科,费县273400 [3]天津市环湖医院神经外科,天津300000

出　　处：《中国综合临床》2023年第4期281-287,共7页Clinical Medicine of China

基　　金：天津市科学技术计划项目(21JCZDJC00460)。

摘　　要：目的探讨负压性脑积水患者的临床表现、发病机制、诊断、治疗及预后。方法回顾性分析2019年1月至2021年12月天津市环湖医院神经外科收治的5例负压性脑积水患者的临床资料,所有患者均行腰椎穿刺及脑室穿刺测压、CT脑池造影等检查,测量患者脊髓蛛网膜下腔与脑室内压力,根据不同情况行脑室外低位引流及内镜下三脑室底造瘘等治疗,观察患者转归。结果经测量5例患者脊髓蛛网膜下腔压力与脑室内压力不相等,且脑室内压力为负。脑池造影显示5例病例均存在脑脊液循环梗阻。1例患者经脑室外低位负压引流后症状好转,3例患者进一步行三脑室底造瘘术后临床症状好转,1例患者出现肺部感染未进一步手术治疗。结论存在脑脊液循环梗阻的情况下,侧脑室、蛛网膜下腔压力不等,当脑组织压或蛛网膜下腔压力下降时,侧脑室与蛛网膜下腔产生压力梯度,在压力梯度作用下脑室扩张,脑室内压下降甚至为负压,这可能是负压性脑积水的发病机制。CT脑池造影为该疾病的诊断及明确其机制提供有力证据,脑室外低位引流及三脑室底造瘘是有效的治疗方法。Objective To investigate the clinical manifestations,pathogenesis,diagnosis and treatment of negative pressure hydrocephalus(NPH).Methods A retrospective analysis was performed on the 5 patients with NPH admitted to the Department of Neurosurgery,Tianjin Huanhu Hospital from January 2019 to December 2021.All of the patients underwent lumbar puncture and ventricular puncture to test the pressure.Three patients underwent endoscopic third ventriculostomy(ETV),the outcome of the patients was observed.Results The pressure of subarachnoid was not equal to intraventricular,and the pressure of intraventricular was negative.Cisternography showed cerebrospinal fluid circulation obstruction in all 5 cases.The symptoms of 1 patient were improved after external negative pressure drainage,3 patients were improved after further ETV and 1 patient had pulmonary infection without further surgical treatment.Conclusion With the obstruction of cerebrospinal fluid circulation,the pressure of lateral ventricle and subarachnoid is different,when the pressure of brain or subarachnoid drop,the ventricular expansion under the effect of pressure gradient,intraventricular pressure drop even for the negative pressure.CT cisternography provides strong evidence for the diagnosis of this disease.External ventricular drainage with negative pressure and ETV are effective treatment methods.

关 键 词：负压性脑积水 梗阻性脑积水 脑池造影 三脑室底造瘘 

分 类 号：R742.7[医药卫生—神经病学与精神病学]