可调压分流管治疗颅内静脉异常回流所致高颅压性脑积水

Pressure-adjustable shunt in treatment of hydrocephalus associated with congenital intracranial anomalous venous return

目的 探讨可调压分流管治疗先天性颅内静脉回流异常所致脑积水的应用价值.方法 2例男性患儿行CT、MRI提示脑室系统扩张,MRV及DSA检查发现颅内静脉窦广泛闭塞.腰穿压力显著升高.手术均采用强生可调压分流管行脑室-腹腔体外可调压分流术治疗.结果 2例患者术中均将分流阀压力设定为200 mmH2O,术后逐步调低,调低至180 mmH2O均出现不同程度低颅压症状,调高后症状缓解,2例患者术后智力及运动功能显著提高,复查CT提示脑室减小.结论 先天性颅内静脉异常回流导致的高颅压性脑积水非常少见,治疗经验甚少.可调压分流显然是治疗颅内静脉回流导致高颅压性脑积水一种最佳治疗方法,对压力调节,需通过较长时间多次调节来逐步达到一个合适的个体压力.

Objective To investigate the value of Codman Hakim pressure - adjustable shunt in the treatment of hydrocephalus associated with congenital intracranial anomalous venous return. Methods 2patients whose diagnosis were confirmed by CT,MRI, MRV and DSA and programmable ventriculoperitoneal shunting was given. Results The pressure of 2 cases of patients undergoing shunt valve was set to 200mmH2O in operation and the pressure was reduce gradually. The patients developed symptoms of low intracranial pressure in different degrees when the pressure was reduced to 180 mmH2O. The symptoms were alleviated after the pressure was increased. The mental and motor function of 2 patients were improved significantly and CT examinations showed decreased ventricles. Conclusious The hydrocephalus associated with congenital intracranial anomalous venous return is rare and the treatment experience is not enough. Pressure-adjustable shunting is the best treatment for this kind of hydrocephalus. The pressure should be adjusted several times for a long time to achieve a suitable individual pressure gradually.