Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension
Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension
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DOI：
10.3171/2012.3.peds11228
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发表时间：
2012-07-01
影响因子：
1.9
通讯作者：
Ghatan, Saadi
中科院分区：
文献类型：
--
作者：
Ellis, Jason A.;Anderson, Richard C. E.;Ghatan, Saadi
Object.特发性颅内高压（IIH）可能是难治性的可用的药物和手术治疗。患有这种疾病的患者可能患有顽固性头痛，视力下降，或有其他与颅内压升高相关的症状。颅内扩张术（ICE）是作者开发的一种新型外科手术，用于治疗患有这种疾病的患者。在这里，他们描述了ICE并介绍了他们使用这种外科手术治疗难治性IIH患者的初步经验。方法。作者对5年期间接受ICE治疗IIH的10例连续患者进行了回顾性分析。比较术前和术后的临床参数，包括患者症状、视乳头水肿的存在和可用的ICP或CSF开放压。记录了手术细节和并发症。使用术前和术后CT扫描计算颅内体积增加。10例患者随访1 ~ 39.6个月，平均15.5个月。在队列中的所有患者中进行了技术成功的ICE。手术并发症包括1例患者的单次术后癫痫发作和另1例患者的矢状窦撕裂，无临床后遗症。在末次随访时，10例患者中有7例（70%）的症状改善或无症状。9例术前头痛患者中有6例（67%）症状减轻或消退，所有术前视神经乳头水肿患者（4例）症状减轻或完全消退。所有受试患者（4/4）的术后ICP或CSF开放压均正常。术后颅内容积扩张3.8%~ 12%。颅内扩张术是治疗难治性IIH患者的一种安全有效的手术。该手术扩大了颅内体积，从而促进ICP正常化，这可能导致IIH的体征和症状减轻或完全消退。颅内扩张可作为难治性IIH治疗中多学科管理方法的一部分。(http：//thejns.org/doi/abs/10.3171/2012.3.PEDS11228）
Object. Idiopathic intracranial hypertension (IIH) may be refractory to available medical and surgical therapies. Patients with this condition may suffer from intractable headaches, experience visual deterioration, or have other symptoms related to elevated intracranial pressure. Internal cranial expansion (ICE) is a novel surgical procedure that the authors have developed for the treatment of patients with this condition. Here, they describe ICE and present their initial experience in using this surgical procedure for the treatment of patients with refractory IIH.Methods. The authors conducted a retrospective review of 10 consecutive patients who underwent ICE for the treatment of IIH during a 5-year period. Preoperative and postoperative clinical parameters including patient symptoms, presence of papilledema, and available ICP or CSF opening pressures were compared. Procedural details and complications were noted. Intracranial volume increases were calculated using available pre- and postoperative CT scans.Results. Follow-up for the 10 patients in this series ranged from 1 to 39.6 months (mean 15.5 months). Technically successful ICE was performed in all patients within the cohort. Surgical complications included a single postoperative seizure in one patient and a sagittal sinus tear with no clinical sequelae in another patient. At the time of last follow-up, 7 (70%) of 10 patients were either symptomatically improved or asymptomatic. Six (67%) of 9 patients with preoperative headaches had reduction or resolution of this symptom, and all patients (4 of 4) with preoperative papilledema had a reduction in or complete resolution of this sign. Postoperative ICP or CSF opening pressures were normal in all patients (4 of 4) tested. Postoperative intracranial volume expansion ranged between 3.8% and 12%.Conclusions. Internal cranial expansion is a safe and effective surgery for the treatment of patients with refractory IIH. This surgery expands the intracranial volume and thus promotes ICP normalization, which may lead to the reduction or complete resolution of the signs and symptoms of IIH. Internal cranial expansion may be used as part of a multidisciplinary management approach in the treatment of refractory IIH. (http://thejns.org/doi/abs/10.3171/2012.3.PEDS11228)