成人长期显著性脑室扩张症的临床诊断与治疗分析

Clinical diagnosis and treatment of long-standing overt ventriculomegaly in adults

摘要:

目的 探讨成人长期显著性脑室扩张症的诊断与治疗。方法 回顾性分析我院神经外科收治的成人长期显著性脑室扩张症17例患者的临床特点，诊断，治疗及预后。结果 17例患者中，男女之比为1.4：1（男10，女7），平均年龄46.3岁（27岁~58岁）。主要临床表现为头痛（100%）及认知功能障碍（72.22%，13例）。17例患者共21次手术，随访6月~8年，症状均得到不同程度的改善，本组无死亡病例。4例行定压脑室-腹腔分流术，其中3例术后症状加重，须再次手术，改为可调压分流管。行可调压脑室-腹腔分流术者，术后均经3次以上压力调整。8例行神经内镜三脑室底造瘘术，术后1例出现硬膜下血肿，经穿刺外引流后恢复。结论 ①成人长期显著性脑室扩张症是一种特殊类型的脑积水，须经过严格术前评估②手术方式应选择可调压脑室-腹腔分流或三脑室底造瘘。

Abstract:

Objective To investigate the diagnosis and treatment of long-standing overt ventriculomegaly in adults (LOVA).Methods The clinical features, diagnosis, treatment, and prognosis of 17 patients with LOVA admitted to the Department of Neurosurgery in our hospital were analyzed retrospectively.Results Among the 17 cases, the male/female ratio was 1.4:1 (10 males and 7 females), with a mean age of 46.3 years (range 27-58 years). The main clinical manifestations were headache (100%) and cognitive disorder (72.22%, 13 cases). The 17 cases underwent 21 times of surgery, were followed up for 6 months to 8 years, and showed varying degrees of improvement in symptoms. There were no deaths reported. Four cases underwent differential pressure valve (DPV) ventriculoperitoneal shunt, and three cases were aggravated after operation and needed to be converted to pressure-programmable valve (PPV) ventriculoperitoneal shunt. Each case treaded by PPV ventriculoperitoneal shunt underwent pressure adjustment at least three times. Eight cases underwent endoscopic third ventriculostomy (ETV), and one case had subdural hematoma after operation, which was removed by percutaneous external drainage.Conclusions LOVA is a special form of hydrocephalus and needs strict preoperative assessment. The surgical procedure should be PPV ventriculoperitoneal shunt or ETV.