低颅压性脑积水的诊断及治疗(附5例分析)

Diagnosis and treatment of low pressure hydrocephalus:report of 5 cases

目的探讨低颅内压脑积水(LPH)的临床表现、治疗方法及诊治经验。方法选自2012年10月至2015年12月南通市第一人民医院神经外科收治的LPH患者5例,均采用可调压分流管行脑室-腹腔分流术(VPS)治疗。术前腰穿证实为LPH患者2例,另外3例为正常压力脑积水内引流后的随访中根据症状反复调压后确诊。结果 5例患者VPS治疗后随访2~28个月,所有患者术后症状均有不同程度缓解,并且扩大的脑室回缩。结论 LPH临床少见,表现类似于正常颅压脑积水;头部CT及MRI可表现为脑室扩大,脑室周围水肿;可调压管行VPS是治疗LPH的有效方法。可调压力阈引流管的使用价值在于可以有效的针对不同的个体进行调节,可以有不止一次的调整和长期疗效的观察。

Objective To explore the clinical symptoms,diagnosis and treatment of low intracranial pressure hydrocephalus（LPH）. Methods The ventriculo-peritoneal shunt（VPS） with pressure-adjustable valves was performed in 5 patients with low intracranial pressure hydrocephalus in Nantong First People＇s Hospital from October 2012 to December 2015. The diagnosis of LPH in 2patients was definitely made by lumbar puncture drainage before VPS. LPH developed during the following-up during which the patients＇ symptoms were not improved untile the drainage under the negative pressure in 3 patients with normal pressure hydrocephalus. Results The following-up from 2to 28 months after VPS showed that the clinical symptoms were improved and the enlarged ventricles significantly retracted in all patients. Conclusion LPH is uncommon and occultly comes on. LPH is similar to normal pressure hydrocephalus in the clinical manifestation. CT and MRI show that there are ventriculomegaly in all the patients with LPH and periventricular edema in some patients with LPH. VPS with pressure-adjustable valve is an effective method to treat LPH. The perfect threshold value of pressure adjustable valves,which is suitable for the individual,may be got by more than once adjustment and long-term observation of the curative effect.