颞叶蛛网膜囊肿-腹腔分流术后分流管依赖综合征13例并文献复习

Shunt dependency after cyst - peritoneal shunting for the arachnoid cyst of the temporal lobe： report of thirteen cases and literature review

目的 探讨颞叶蛛网膜囊肿-腹腔分流术后分流管依赖综合征的发生机制、诊断标准及治疗方法。方法对2010年4月至2012年1月北京天坛医院A,JL病区收治的13例颞叶蛛网膜囊肿-腹腔分流术后分流管依赖患者的临床资料进行回顾性分析，并对相关文献进行复习。结果13例患者，男10例，女3例，平均年龄12．3岁（5．5—24．0岁），首发症状多为头痛及恶心呕吐等高颅压症状，影像学上蛛网膜囊肿多显著缩小（12例），脑室正常或小于正常，颅内压监测和（或）腰穿结果显示颅内压力较高。13例患者中，3例患者接受分流管调整术，4例接受脑室-腹腔分流术，6例接受腰大池-腹腔分流术。随访时间12～36个月（平均20个月），13例患者症状均明显缓解。结论分流管依赖综合征是蛛网膜囊肿-腹腔分流术后一种非常严重的并发症，与裂隙脑室综合征相似而又不完全相同；颅内压监测对诊断分流管依赖综合征有非常重要的意义。

Objective To investigate the mechanism, diagnosis, and treatment of shunt dependency syndrome in patients with temporal lobe arachnoid cysts who were initially treated with cystoperitoneal （CP） shunting. Methods Thirteen patients with temporal lobe arachnoid cysts who had initially been with CP shunts placement and had developed shunt dependency syndrome were treated by the authors at Tiantan Hospital between April 2010 and January 2012. The clinical manifestation, neuroimaging findings, intracranial pressure （ICP） data, treatment methods, and therapeutic results were reviewed retrospectively. Results The study included 10 males and 3 females. The mean age at the time of development of shunt dependency was 12. 3 years （range 5. 5 - 24. 0years）. In most patients, neuroimaging findings showed a collapsed cyst （the cyst appeared almost unchanged in only one patient） and normal or small ventricles （only one patient had enlarged ventricles）. Three patients underwent simple replacement of the shunt, four underwent ventriculoperitoneal shunt placement, and the other six underwent lumboperitoneal shunt placement. All patients experienced resolution of their symptoms postoperatively. The mean duration of follow - up was 20 months. Conclusions Shunt dependency syndrome was a rare but serious complication of cystoperitoneal （CP） shunting for arachnoid cysts. The condition was similar to the slit ventricle syndrome, but also had some differences. ICP monitoring could confirm the diagnosis when there was no significant radiological findings.