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
低
脑积水
儿童
分流障碍
诊断
Vision,low
Hydrocephalus
Child
Shunt dysfunction
Diagnosis