期刊文献+

以视力下降为主要表现的儿童脑积水术后分流障碍的临床研究:附五例报告 被引量:2

Clinical study on ventriculoperitoneal shunt dysfunction characterized by vision problems post hydrocephalus surgery in children:a report of 5 cases
原文传递
导出
摘要 目的探讨以视力下降为主要表现的脑积水术后分流障碍患儿的临床特点、诊治方法及临床结局。方法回顾性分析2015年10月至2019年10月上海交通大学医学院附属上海儿童医学中心神经外科收治的5例以视力下降为主要表现的脑室-腹腔(V-P)分流术后分流障碍患儿(占同期收治的96例V-P分流障碍患儿的5.2%)的临床资料。既往均因脑积水于出生后6个月内行V-P分流术。此次发病的病程为2 d至2年。此次入院所有患儿均行分流管修复术,术后均予门诊随访和影像学随访评估手术结局。结果5例患儿中,2例以头痛伴急性视力下降就诊;3例以视力下降伴或不伴复视、斜视就诊。术前头颅CT结果显示,1例患儿脑室增大,4例患儿脑室未见明显增大。术前X线片显示4例为分流管断裂、1例经手术探查发现为分流管脑室端堵塞。行分流管修复术后分流管通畅。5例患儿术后随访4~49个月,术前的头痛等颅高压症状均消失,但视觉障碍均无明显改善,3例患儿存在视神经萎缩。结论以视力下降为主要表现的脑积水术后分流障碍的发病率较低,可伴有颅高压症状,且易误诊而延误治疗。头颅CT、全程X线片和眼底检查是确诊V-P分流术后分流障碍的重要检查方法。分流管修复术对术前已存在的视力下降效果不佳,应尽早明确诊断,积极手术有可能缓解或避免视力问题进一步加重。 Objective To investigate the clinical characteristics,diagnosis and surgical outcomes of ventriculoperitoneal(VP)shunt dysfunction post hydrocephalus surgery in children.Methods From October 2015 to October 2019,a total of 96 children were admitted to Department of Neurosurgery,Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiaotong University and 5(5.2%)of whom had vision problems as the primary symptom of VP shunt dysfunction.We retrospectively analyzed the clinical data of those 5 cases.All 5 cases underwent VP shunt within half a year after birth for hydrocephalus.The course of disease ranged from 2 days to 2 year.Replacement of the catheter was performed in 5 children at our department.Outpatient and imaging follow-up were conducted to assess the surgical outcomes.Results Among the 5 children,2 presented with headache and acute vision decline;3 cases presented with decreased vision,with or without diplopia or strabismus.Preoperative CT results indicated ventricular enlargement in 1 child rather than the remaining 4.Intraoperative X-ray results showed breakage of the shunt catheters in 4 cases and blockage of the catheter in its ventricular end in 1 case.The postoperative follow-up period of 5 patients ranged from 4 to 49 months.Preoperative headache and other symptoms of intracranial hypertension disappeared,while there was no obvious improvement in visual impairment.Three cases of children had optic nerve atrophy.Conclusions The incidence of vision decline as the primary symptom of VP shunt dysfunction post hydrocephalus surgery seems low,which has a tendency of being misdiagnosed as simple visual impairment resulting in delayed treatment.Head CT,X-ray of full-length shunt catheters and fundus examination are important examinations for the diagnosis of VP dysfunction.Shunt repair surgery may not work well for the vision loss that has been caused,and the diagnosis should be confirmed as soon as possible.Active surgery may alleviate or avoid further aggravation of vision problems.
作者 邱姗姗 鲍南 杨波 宋云海 Qiu Shanshan;Bao Nan;Yang Bo;Song Yunhai(Department of Neurosurgery,Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)
出处 《中华神经外科杂志》 CSCD 北大核心 2021年第3期276-280,共5页 Chinese Journal of Neurosurgery
关键词 视力 脑积水 儿童 分流障碍 诊断 Vision,low Hydrocephalus Child Shunt dysfunction Diagnosis
  • 相关文献

参考文献3

二级参考文献20

  • 1鲍南,顾硕,吴晔明,洪莉,施诚仁.脑室镜三脑室造瘘术治疗小儿阻塞性脑积水[J].中华神经外科杂志,2006,22(9):519-521. 被引量:28
  • 2宗绪毅,张亚卓.应用神经内镜行三脑室底造瘘术治疗梗阻性脑积水[J].中华医学杂志,2006,86(41):2905-2907. 被引量:30
  • 3Li KW, Nelson C, Suk I, et al. Neuroendoscopy: past, present, and future [ J ]. Neurosurg Focus, 2005,19 (6) : E1.
  • 4Salvador SF, Oliveira J, Pereira J, et al. Endoscopic third ventri- culostomy in the management of hydrocephalus : Outcome analysis of 168 consecutive procedures[ J]. Clin Neurol Neurosurg,2014, 126 : 130-136.
  • 5Kehler U, Gliemroth J. Extraventricular intracisternal obstructive hydrocephalus--a hypothesis to explain successful 3rd ventricu- lostomy in communicating hydrocephalus [ J ]. Pediatr Neurosurg, 2003,38(2) :98-101.
  • 6Vogel TW, Bahuleyan B, Robinson S, et al. The role of endos- copic third ventriculostomy in the treatment of hydrocephalus [ J ]. J Neurosurg Pediatrics ,2013,12:54-61.
  • 7Kulkarni AV, Drake JM, Mallucci CL, et al. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus [ J ]. J Pediatr,2009, 155 (2) :254-259. e1.
  • 8Wagner W,Koch D. Mechanisms of failure after endoscopic third ventriculostomy in young infants [ J ]. J Neurosurg, 2005,103 ( 1 Suppl) :43-49.
  • 9Marano PJ, Stone SS, Mugamba J, et al. Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants[J]. J Neurosurg Pediatr,2015, 15 (4) :399-405.
  • 10Dinner A, Kohan S, Ozek MM. Is all " communicating" hydro- cephalus really communicating? Prospective study on the value of 3D-constructive interference in steady state sequence at 3T[ J]. AJNR Am J Neuroradiol, 2009,30 ( 10 ) : 1898-1906.

共引文献13

同被引文献20

引证文献2

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部