侧裂蛛网膜囊肿-腹腔分流术后高颅压的原因和治疗

Cause and treatment of intracranial hypertension after sylvian cystoperitoneal shunting

目的 分析侧裂蛛网膜囊肿-腹腔分流术后高颅压的原因,总结治疗经验.方法 颅内蛛网膜囊患者16例,男10例,女6例,男女之比10∶6.年龄2～19岁,平均9.94岁.全部16例患者使用普通低压型分流管,行侧裂蛛网膜囊肿-腹腔分流术.结果 分流术后出现颅压高症状的时间为3个月～7年,平均3.20年.2例行分流管调整术;12例拔除原分流管后,10例行侧脑室-腹腔分流术,其他2例和2例未拔管患者脱水治疗有效.结论 出现高颅压的原因可能是囊肿消失或缩小后,分流管出现引流不足或堵塞,导致脑脊液分泌吸收失平衡.在药物脱水无效和自身无法代偿的情况下,调整分流管位置或行侧脑室-腹腔分流术具有立竿见影的效果.

Objective To analyze the cause and treatment of intracranial hypertension after sylvian cystoperitoneal shunting. Methods Sixteen cases were retrospectively reviewed. There were 10 males and 6 females. The age range was 2-19 years old （mean： 9.94）. All patients had a sylvian cystoperitoneal shunt via a common low-pressure tube. Results The onset time of intracranial hypertension after cystoperitoneal shunting was 3 months to 7 years （ mean： 3.20 yr）. Three cases underwent the operation of adjusting intracranial location of shunt tube. The original tube was removed in 12 cases. Among them, 10 cases were operated by lateral ventricle-peritoneal shunt. The other two and two cases with a remaining tube were treated successfully with dehydration drugs. Conclusion The cause of intracranial hypertension is probably due to tube blockage or less draining after the shrinking or disappearance of arachnoid cyst. Adjusting the location of intracranial tube or performing a lateral ventricle-peritoneal shunt has an excellent efficacy if a dehydration therapy is unresponsive or auto-compensation fails.