Management of Pyogenic Cerebral Ventriculitis by Neuroendoscopic Surgery
Management of Pyogenic Cerebral Ventriculitis by Neuroendoscopic Surgery
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神经内镜手术治疗化脓性脑室炎
DOI：
10.1016/j.wneu.2016.10.103
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发表时间：
2017-02-01
影响因子：
2
通讯作者：
Sun, Tao
中科院分区：
文献类型：
--
作者：
Wang, Fei;Yao, Xiao-Yan;Sun, Tao
背景技术背景：化脓性脑室炎是一种颅内感染的衰弱形式，由于缺乏手术治疗经验，结果不佳。目的：回顾性研究一组通过神经内镜手术（内斯）治疗的化脓性脑室炎患者。方法：内斯治疗该病的标准脑室内方案包括以下1种或多种：1）碎片闭塞，2）微生物感染的证据，3）分隔切开术，4）分隔切开术，或5）监测导管插入。当脑室内碎片和细菌斑块不能完全清除时，改良脑室外引流EVD（mEVD）联合内斯。根据最后一次内斯后3周左右的临床表现、脑脊液分析和mEVD阻断试验确定后续手术治疗策略。5例患者接受了1次内斯，18例接受了2次，16例接受了3次，2例接受了4次。所有患者均接受了mEVD，平均住院时间为27.6天。出院时，15例患者治愈，15例治愈但依赖脑室腹腔分流，9例依赖mEVD，2例死亡（平均改良兰金量表评分为2.48）。2例mEVD依赖患者死亡，术后随访期间无其他结局变化（平均改良兰金量表评分，2.67）。结论：结果表明，内斯治疗化脓性脑室炎的结局相对较好。这些技术和策略具有一定的实用性，值得推广应用。
BACKGROUND: Pyogenic cerebral ventriculitis is a debilitating form of intracranial infection with an unfavorable outcome as a result of lack of experience in surgical management.OBJECTIVE: To study retrospectively a group of pyogenic cerebral ventriculitis patients managed by neuroendoscopic surgery (NES).METHODS: The standard intraventricular protocols of NES to treat this disease included 1 or more of the following: 1) obliteration of debris, 2) evidence of microbial infection, 3) septomy, 4) incision of the septation, or 5) monitoring catheter insertion. Modified external ventricular drainage EVD (mEVD) was combined with NES when intraventricular debris and bacterial plaques could not be evacuated completely. Subsequent surgical treatment strategies depended on the clinical manifestation, cerebrospinal fluid analysis, and mEVD blockage tests approximately 3 weeks after the last NES.RESULTS: Forty-one patients, who were distributed in 7 hospitals and underwent NES, were included. Five patients received 1 NES, 18 received 2, 16 received 3, and 2 received 4. mEVD was performed in all patients, and mean mEVD duration in the hospital was 27.6 days. At discharge, 15 patients were cured, 15 were cured but ventriculoperitoneal shunt dependent, 9 were mEVD dependent, and 2 died (mean modified Rankin Scale score was 2.48). Two mEVD-dependent patients died, and no other outcomes changed during postoperative follow-up (mean modified Rankin Scale score, 2.67).CONCLUSIONS: The results suggest a relatively favorable outcome for management of pyogenic cerebral ventriculitis by NES. The techniques and strategies are practical and should be applied more extensively.