胸骨前切口接驳可调压抗重力阀治疗小儿裂隙样脑室综合征

The implantation of adjustable gravitational-valve proSA on the sternum to treat pediatric slit ventricle syndrome.

目的探究在原有分流系统基础上采用胸骨前切口接驳可调压抗重力阀治疗裂隙样脑室综合征(slit ventricle syndrome,SVS)的可行性和有效性。方法纳入<14岁脑积水分流术后出现裂隙样脑室综合征患儿4例,经胸骨前切口于原分流系统中植入可调压抗重力阀,术后随访2年,监测并记录临床症状、分流阀压力、脑室扩张等情况。结果4例SVS患儿原可调压分流阀(differential pressure valve,DPV)压力分别由180、180、130、200 mmH2O下调为110、90、130、130 mmH2O,可调压抗重力阀压力由最初25、20、25、30 cmH2O逐渐升至35、25、36、32 cmH2O,患儿头痛、头晕等临床症状均得到明显缓解,额枕/颅径比(fronto-occipital horn ratio,FOHR)分别从术前的0.176、0.217、0.179、0.205逐渐升至0.347、0.386、0.335、0.392,与正常值0.37基本无差异。另1例SVS患儿术前合并硬膜下积液,经治疗后脑室复胀,硬膜下积液吸收完全。4例患儿脑肿胀改善,脑沟脑回形态正常。结论经胸骨前切口植入可调压抗重力阀可能是治疗患儿SVS有效方法。

Objective The aim of this study was to explore the feasibility and effectiveness of implanting adjustable gravitational-valve proSA on the sternum in post-shunt system for treating pediatric slit ventricle syndrome(SVS).Methods Four post-shunt SVS pediatric patients age less than 14 were included.Patients received a shunt revision surgery to implant the adjustable gravitational-valve proSA on the sternum.Clinical outcome,valve pressure and ventricle expansion were recorded and analyzed during 2 years follow-up period.Results Differential pressure valve(DPV)pressure setting in four patients were adjusted from primary 180,180,130 and 200 mmH2O to final 110,90,130 and 130 mmH2O,respectively.ProSA pressure setting was adjusted from primary 25,20,25 and 30 cmH2O gradually to final 35,25,36 and 32 cmH2O,respectively.Clinical symptoms like headache,dizzies were completely released.The fronto-occipital horn ratio(FOHR)increased gradually from pre-operative 0.176,0.217,0.179 and 0.205 to post-operative 0.347,0.386,0.335 and 0.392,respectively which is almost identical to normal FOHR value 0.37.The pre-operative subdural effusion was absorbed completely in one patient after proSA implantation.Brain swelling were improved and sulcus gyrus shape gradually returned to normal in all patients.Conclusions The implanting adjustable gravitational valve proSA on the sternum is a potentially effective way in treatment of pediatric SVS.