Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus
Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus
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DOI：
10.3171/2015.10.peds15398
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发表时间：
2016-05-01
影响因子：
1.9
通讯作者：
Jane, John A., Jr.
中科院分区：
文献类型：
--
作者：
Pomeraniec, I. Jonathan;Ksendzovsky, Alexander;Jane, John A., Jr.
目的脑室内出血（IVH）是早产低出生体重儿的常见并发症，常导致脑积水，需行脑室腹腔分流术治疗。第四脑室（TFV）被困可能是随后的大脑导水管和Luschka和Magendie.METHODS孔闭塞的破坏性后果，作者回顾性分析了2003年至2012年期间因早产儿进行VP分流治疗IVH后TFV的8例连续病例。患者的胎龄范围为23.0 - 32.0周，首次分流术的平均年龄为6.1周（范围3.1-12.7周）。3例患者行手术治疗。患者接受了长期的放射学（平均7.1年，范围3.4-12.2年）和临床（平均7.8年，范围4.6-12.2年）following.Results的频率TFV VP分流新生儿出血后脑积水被发现是15.4%。3例（37.5%）患者出现后颅窝压迫症状并接受手术治疗。所有这些患者在术后随访期间均表现出影像学改善的迹象，临床检查稳定或改善。在接受保守治疗的5例患者中，80%的患者心室大小稳定，1例患者在成像上略微增加（3 mm）。所有的非手术患者表现出稳定的改善临床检查在随访periods.CONCLUSIONS过早IVH患者之间的TFV的频率是相对较高的。大多数TFV患者在就诊时无症状，无需手术即可治疗。有症状的病人可以手术治疗，进行第四脑室减压。
OBJECTIVE Intraventricular hemorrhage (IVH) is a common complication of premature neonates with small birth weight, which often leads to hydrocephalus and treatment with ventriculoperitoneal (VP) shunting procedures. Trapped fourth ventricle (TFV) can be a devastating consequence of the subsequent occlusion of the cerebral aqueduct and foramina of Luschka and Magendie.METHODS The authors retrospectively reviewed 8 consecutive cases involving pediatric patients with TFV following VP shunting for IVH due to prematurity between 2003 and 2012. The patients ranged in gestational age from 23.0 to 32.0 weeks, with an average age at first shunting procedure of 6.1 weeks (range 3.1-12.7 weeks). Three patients were managed with surgery. Patients received long-term radiographic (mean 7.1 years; range 3.4-12.2 years) and clinical (mean 7.8 years; range 4.6-12.2 years) follow-up.RESULTS The frequency of TFV following VP shunting for neonatal posthemorrhagic hydrocephalus was found to be 15.4%. Three (37.5%) patients presented with symptoms of posterior fossa compression and were treated surgically. All of these patients showed signs of radiographic improvement with stable or improved clinical examinations during postoperative follow-up. Of the 5 patients treated conservatively, 80% experienced stable ventricular size and 1 patient experienced a slight increase (3 mm) on imaging. All of the nonsurgical patients showed stable to improved clinical examinations over the follow-up period.CONCLUSIONS The frequency of TFV among premature IVH patients is relatively high. Most patients with TFV are asymptomatic at presentation and can be managed without surgery. Symptomatic patients may be treated surgically for decompression of the fourth ventricle.