腰骶部囊性脊柱裂合并脑积水20例分析

Analysis of 20 Cases of Hydrocephalus Combined with Lumbosacral Cystoid Spina Bifida

目的增强对腰骶部囊性脊柱裂合并脑积水的认识,探讨分流手术时机,改进手术治疗方法。方法回顾性分析32例腰骶部囊性脊柱裂合(其中20例并脑积水)患儿的临床表现、CT特点和手术结果。结果32例腰骶部囊性脊柱裂患儿,合并脑积水者达20例,其中脑积水发生在脊膜修补术后者14例。表现为前囟张力升高、呕吐、精神状态变差和切口脑脊液漏。CT检查显示侧脑室小额角大枕角。结论腰骶部囊性脊柱裂并发脑积水几率较高,可发生在脊膜修补术前后;前囟张力升高是脑积水的重要表现;脑积水分流时机最好和修补术同时进行,脑室穿刺以枕角容易成功。

Objective To improve the recognition of lumbosacral cystoid spina bifida combined with hydrocephalus ; discuss the time of surgery of ventriculoperitoneal shunt （ VPS）, improve surgical therapy method. Methods The clinical manifestations, CT findings and surgical results of 32 cases of lumbosacral cystoid spina bifida combined with hydrocephalus were analyzed retrospectively. Results In the 32 lumbosacral cystoid spina bifida cases ,20 cases combined with hydrocephalus, of them, hydrocephalus developed after the restoration of bifida in 14 cases. Its manifestations included higher anterior fontanel tension, vomiting, mental status deteriation and leakage of cerebrospinal fluid （CSF）from incisions. CT scan revealed the lateral ventricles have a characteristic shape, with small frontal and large occipital horns. Conclusions The probability of lumbosacral cystoid spina bifida combined with hydrocephalus is not low,it can happen before or after the restoration of bifida. The tension of anterior fontanel turning higher is the important manifestation of hydrocephalus. Carrying out VPS and restoration simultaneously is the best choice, puncturing the occipital horn of lateral ventricle is easier way to success.