低颅压性脑积水6例临床分析

Clinical analysis of 6 cases of low pressure hydrocephalus

目的探讨低颅压性脑积水的临床诊断和治疗策略。方法回顾性分析我院2013-2019年收治的6例低颅压性脑积水患者的临床资料并结合文献进行分析。脑室腹腔分流术后4例,颅骨修补术后1例,外伤性脑脊液鼻漏1例。6例腰穿初始压和侧脑室内初始压均<70 mmH_2O,其中腰穿初始压最高60 mmH_2O,最低负压;侧脑室内初始压最高65 mmH_2O,最低为-20 mmH_2O,两者之间存在压力梯度差(5~20 mmH_2O)。6例均行额部钻孔Omaya囊置入侧脑室额角低压持续外引流,引流时间4~36周。结果临床症状消失4例,明显改善2例,CT平扫显示脑室系统恢复正常,脑沟脑回重现。无颅内感染、硬膜下出血等并发症。随访12~70个月,1例于出院6个月后因肝癌死亡;1例因脑肿瘤复发播散继发高压性脑积水再行脑室腹腔分流,术后6个月因原发病进展而死亡;1例于出院后5个月因常压性脑积水复发在外院再行脑室腹腔分流术;另3例治愈,生活自理,无再行脑室腹腔分流术。结论低颅压性脑积水的蛛网膜下腔与侧脑室内压力存在压力梯度差;经右额Omaya囊多次穿刺行侧脑室持续长时间低压外引流是治疗低颅压性脑积水的有效方法。

Objective To explore the clinical diagnosis and treatment strategy of low pressure hydrocephalus(LPH).Methods The clinical data of 6 patients with LPH admitted in our hospital were analyzed retrospectively in conjunction with the literature from 2013 to 2019.There were 4 cases after ventriculoperitoneal shunt,1 case with cranioplasty and 1 case with traumatic cerebrospinal fluid rhinorrhea.The initial pressure of lumbar puncture and lateral ventricle were less than 70 mmH2O in 6 patients,ranging from highest initial pressure at 60 mmH2O in lumbar puncture and65 mmH2O in lateral ventricle to the lowest at negative value in lumbar puncture and-20 mmH2O in lateral ventricle.There was a pressure gradient difference(5~20 mmH2O)between lumbar puncture and lateral ventricle.External ventricular drainage with low pressure was performed with the help of Omaya reservior.The drainage time varied from 4 weeks to36 weeks.Results The clinical manifestations disappeared in 4 cases and improved significantly in 2 cases.CT scan showed that the ventricular system returned to normal and the sulci gyrus recurred.There were no complications such as intracranial infection and subdural hemorrhage.During the follow-up period of 12~70 months,one patient died of liver cancer 6 months after discharge;one patient died of primary disease progression after VP shunt because of recurrence and dissemination of brain tumor and secondary high-pressure hydrocephalus;one patient had a recurrence of normal pressure hydrocephalus 5 months after discharge and then VP shunt was performed in other hospital,the other three patients were cured and took care of themselves without VP shunt.Conclusion There is a pressure gradient difference between the subarachnoid space and the lateral ventricles of LPH.It is an effective way for the treatment of LPH to repetitively puncture the right frontal Omaya reservior combined with a long-term continuous low pressure external ventricular drainage.