脑室-腹腔分流治疗重型颅脑损伤术后脑积水合并硬膜下积液

Treatment with ventriculoperitoneal shunt in hydrocephalus with subdural effusions after operation of severe craniocerebral injury

目的探讨重型颅脑损伤去骨瓣减压术后脑积水合并硬膜下积液行脑室一腹腔分流术（V-P分流术）的治疗效果。方法回顾性分析2009年3月~2012年12月共收治的重型颅脑损伤开颅去骨瓣减压术后脑积水合并硬膜下积液患者的临床资料：9例患者均通过临床表现和影像学检查确诊。其中1例先将硬膜下积液钻孔引流，拔除引流管后硬膜下积液复发，行V-P分流术，其余8例用V-P分流术进行治疗。结果患者出院时进行头颅CT复查，硬膜下积液消退，扩大的脑室缩小或接近正常。随访0．5年～2年：无硬膜下积液复发，无脑积水的临床表现，脑室大小基本正常。本组无死亡病例，按COS评定：良好4例，中残2例，重残2例，植物生存1例。结论对于重型颅脑损伤开颅去骨瓣减压术后脑积水合并硬膜下积液患者，只要硬膜下积液和脑室是自由交通的，用V-P分流手术治疗是有效的和令人满意的。

Objective To evaluate the effect of ventriculoperitonea[ shunt in hydrocephalus with suh- dural effusions after decompressive craniectomy for severe craniocerebral injury. Methods Retrospectively ana- lyzed 9 cases of severe craniocerebral injury after decompressive craniectomy developed hydrocephalus and sub- dural effusions were treated and during Mar. 2009 to Dec. 2012, The diagnosis is determined by clinical manifes- tations and imaging testing. One case of subdural effusions was treated with drill and drainage, bur it recurred after removing drainage tube. We treated it by ventriculoperitoneal shunt. 8 cases were treated with ventriculo- peritoneal shunt only. Results The patients were examined with CT when dischanged. All of them showed subdural effusion regressed,and the enlarged ventricule became narrow or almost normal. With follow-up for six months to 24 months, no patients recurred with subdural effusion and hydrocephalus, the size of ventricu- lar is near to normal. All the 9 cases are all survival.. According to Glasgow outcome score （GOS）, good re- covery in 4 cases, moderate disability in 2 cases, severe disability in 2cases , and 1 case vegetative. Conclusions If the subdural effusion with ventricule are communicant, ventriculoperitoneat shunt is effective and satisfied for severe craniocerebral injury after decompressive craniectomy with accompanying hydrocephalus and sub- dural effusion.