CSF shunt removal in children with hydrocephalus
CSF shunt removal in children with hydrocephalus
复制标题
脑积水儿童脑脊液分流术的去除
DOI：
10.1007/s00701-005-0494-6
复制
发表时间：
2005
影响因子：
2.4
通讯作者：
C. Di Rocco
中科院分区：
文献类型：
--
作者：
A. Iannelli;G. Rea;C. Di Rocco
在脑积水的儿童中，移除先前插入的脑脊液分流装置的可能性是众所周知的，尽管对于儿科神经外科医生来说是罕见的事件。对850例非肿瘤性脑积水患儿的临床资料进行了回顾分析，发现有3.2%的患儿(27例)有明显的分流独立性。植入和移除脑脊液分流术之间的时间间隔为8个月至12年(平均为8年)。分析用于寻找任何预测因素的参数包括：手术年龄、病因、使用的假体类型、插入和移除分流术之间的时间间隔、可能的翻修次数。研究结果表明，在婴儿早期接受手术的患者中，分流独立性的发生率最高，因为27例被移除的分流术中有24例发生在6个月以下的手术患者中，其余2例在2岁以下接受治疗的儿童中发生。这一发现可以解释为这些患者的脑脊液吸收机制成熟延迟，随后恢复正常。至于病因，本组27名患者中有41%受到出血后脑积水的影响，手术治疗时的一系列神经放射学检查和回声多普勒脑部研究表明，这是进行性的。在6名儿童中，脑积水与脊髓脊膜膨出有关。5例患者有导水管狭窄，2例交通性脑积水。我们使用的脑脊液分流系统的类型在确定或促进分流独立性方面没有任何作用。未观察到分流手术的需要和手术次数之间的相关性。分流管插入和移除之间的间隔时间的作用无法分析，因为在脑脊液分流管手术翻修(由于生理体型生长而选择性延长)或脑脊液分流装置断开的放射学证明之前，可能获得分流管独立性。同样的限制阻碍了对分流的脑积水儿童分流独立性的实际总体发生率的评估，因为他们中的一些人可能有一个不起作用的脑脊液分流装置，尽管没有被注意到。
The possibility to remove a previously inserted CSF shunt device in hydrocephalic children is a well known though rare event for paediatric neurosurgeons. A retrospective analysis of our experience with a series of 850 children affected by non tumoral hydrocephalus shows that obvious shunt independence could be demonstrated in 3.2% of the patients (27 cases). The time interval between the CSF shunt insertion and removal ranged between 8 months and 12 years (mean: 8 years).Parameters analysed to search for any predictive elements were age at surgery, aetiology, type of prosthesis utilised, time interval between insertion and removal of the shunt, number of the possible revisions. The results of the study suggest that the highest incidence of shunt independence is reached in subjects operated on in early infancy, as 24 of 27 removed shunts were in patients operated on under 6 months of age, and the remaining in 2 children treated when less than 2 years old. Such a finding could be explained on the grounds of a delay in maturation of the CSF absorption mechanisms followed by a late normalisation in these patients.As regards to aetiology, 41% of the 27 patients considered in this series were affected by a post-haemorrhagic hydrocephalus, which was progressive, as demonstrated by serial neuroradiological examinations and echo-Doppler cerebral studies at the time of the surgical treatment. In six children the hydrocephalus was associated with myelomeningocele. Five patients had aqueduct stenosis and 2 communicating hydrocephalus.The types of CSF shunting system we utilised did not play any role in determining or facilitating shunt independence. No correlation was observed with the need and the number of shunt revisions. The role of the interval time between the insertion and the removal of the shunt was not analysable, because of the possible acquisition of the shunt independence prior to its demonstration at the moment of the surgical revision of the CSF shunt (elective lengthening because of the physiological body growth) or to the radiological demonstration of CSF shunt device disconnection. The same constraint prevents the evaluation of the actual overall incidence of shunt independence in shunted hydrocephalic children, as some of them could have harboured a non-functioning CSF shunt device, though unnoticed.