颅内蛛网膜囊肿-腹腔分流术后分流管依赖二例并文献复习

Shunt dependency following treatment of intracranial arachnoid cyst： report of 2 cases and review of literature

目的探讨颅内蛛网膜囊肿一腹腔分流术后并发分流管依赖的可能机制、影像学特征及治疗方法。方法分析2例蛛网膜囊肿行囊肿一腹腔分流术后并发分流管依赖的诊治过程，并结合文献进行讨论和总结。结果2例均表现为分流管功能丧失后继发严重颅高压症状，其中1例行侧脑室一腹腔分流术；另1例先行囊肿一腹腔分流术，1个月后分流管堵塞，改行腰大池一腹腔分流术。经治疗后2例均痊愈出院，预后良好。结论分流管依赖是继发于分流管功能下降或丧失，临床表现呈持续进展性颅内压增高；影像学上可观察到侧脑室正常或轻度缩小，原囊肿短期内可复现增大；解除分流管梗阻或重新建立脑脊液引流渠道是安全有效的治疗方法。

Objective To discuss the possible mechanism, imaging characteristics, and treatment of shunt dependency following cystoperitoneal shunt of the intracranial arachnoid cyst. Methods The diagnosis criteria and treatment of 2 cases of shunt dependency following the cystoperitoneal shunt of intracranial arachnoid cyst were studied, and the relative literatures were reviewed. Results The development of acute intracranial hypertension during cystoperitoneal shunt malfunction were detected in both 2 cases. One case was treated with the ventriculoperitoneal shunt. The other case first received a cystoperitoneal shunt, and then was treated with the lumbar-peritoneal shunt after a blockage of the cystoperitoneal shunt tube. After treatments, both patients were discharged with good prognosis. Conclusions The possible mechanism of shunt dependency could be described as the ＂disuse decline＂ of cerebrospinal fluid absorption. Relieving the shunt tube obstruction or re-establishment of CSF drainage channels might be the safe and effective treatment of shunt dependency.