Ommaya囊置入术治疗脑积水合并颅内感染的疗效

Clinical efficacy of Ommaya reservoir implantation for patients with hydrocephalus associated with intracranial infection

目的探讨Ommaya囊置入术治疗脑积水合并颅内感染的疗效。方法回顾性分析2019年4月至2020年6月收治的10例脑积水合并颅内感染的临床资料。入院后,均行脑室镜探查+Ommaya囊置入术,术后经Ommaya囊抽取脑脊液,并视病情注射抗生素治疗,动态评估脑积水改善情况及颅内感染控制情况,待脑脊液恢复正常后再次行脑室镜探查,拔除Ommaya囊并行分流手术。结果10例术后脑脊液恢复正常的时间21~36 d,平均(28.4±4.57)d。5例行脑室-腹腔分流术,1例因脑室内粘连严重未行分流术,4例转变为静止性脑积水继续随访。10例出院时GOS评分4分。结论对于脑积水合并颅内感染,Ommaya囊置入术可作为外引流术的替代方案,具备留置时间长、感染风险低等优势,可为后期分流手术争取足够时间窗、降低分流术后并发症发生率;还可经Ommaya囊注射抗生素治疗颅内感染,从而提高治疗成功率。

Objective To investigate the clinical efficacy of Ommaya reservoir implantation in the treatment of hydrocephalus complicated with intracranial infection.Methods The clinical data of 10 patients with hydrocephalus associated with intracranial infection who were admitted to our hospital from April 2019 to June 2020 were retrospectively analyzed.After admission,all patients underwent ventriculoscopic exploration and Ommaya reservoir implantation.After the operation,cerebrospinal fluid was extracted from the Ommaya reservoir,and antibiotics were injected into the Ommaya reservoir to treat intracranial infection.The improvement of hydrocephalus and the control of intracranial infection were dynamically evaluated.Results It took 21~36 days for the cerebrospinal fluid to return to normal,with an average of(28.4±4.57)days.Five patients underwent ventriculoperitoneal shunt,1 patient did not receive shunt due to severe intraventricular adhesion,and 4 patients turned to static hydrocephalus and were followed-up.A GOS score of 4 was achieved in all patients on discharge.Conclusions For hydrocephalus complicated with intracranial infection,Ommaya reservoir implantation can be used as an alternative to external drainage,which has the advantages of long indwelling time and low risk of infection,and can obtain sufficient time window for later shunt surgery and reduce the incidence of postoperative complications.Antibiotics can also be injected into the Ommaya reservoir to treat intracranial infections,thus improving the success rate of treatment.