脑积水分类诊断及治疗的现状与挑战

The status and challenges of classification diagnosis and treatment of hydrocephalus

脑积水是神经外科常见疾病,可单独发生或合并于其他疾病。不论什么原因导致的脑积水,发病机制和病理改变均十分相似。目前脑积水临床诊治面临的主要问题是:病因分类不够准确全面、检查手段有待完善、治疗方法选择上存在争议等。基于这些问题结合文献查阅,脑积水需要有再认识的过程。在分类上,交通性脑积水实质上也属于脑积液循环通路的梗阻范畴,将脑积水按照梗阻部位分类更有利于指导临床工作。脑积水影像学应该充实针对梗阻部位以及了解脑脊液吸收情况的检查。三脑室底造瘘术与脑室腹腔分流术各有优势,应根据适应症进行选择。另外还要强调,对于不同病人应该建立系统的诊治流程以及个性化治疗方案,使脑积水的治疗更加完善合理。

Hydrocephalus is a common disease in neurosurgery, which can occur independently, or is accomplished with other diseases. The pathogenesis and the pathological changes of hydrocephalus were very similar no matter what causes. The diagnosis and treatment of hydrocephalus were facing a lot of challenge： the etiology classification is not comprehensive and accurate enough, the imaging examination method is needed to improve, and the treatment choice is still controversial, and so on. Based on these problems combining with literature review, it is need to make re-recognition of hydrocephalus. Concerning to classification, communicating hydrocephalus is also ascribed to the obstruction of cerebrospinal fluid circulation pathway. Classification of hydrocephalus in accordance with the obstruction site will be more advantageous to guide clinical work. The imaging examination should pay more attention on exploring obstruction site and cerebrospinal fluid absorption conditions. The third ventricle colostomy surgery and ventricle peritoneal shunt both have advantages, it should be choose according to the indication. It should be emphasis that the diagnosis and treatment procedures and personalized therapeutic scheme should be established for different patients with hydrocephalus.