Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis
Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis
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DOI：
10.1097/00006123-200204000-00014
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发表时间：
2002-04-01
期刊：
影响因子：
4.8
通讯作者：
Locke, GE
中科院分区：
文献类型：
--
作者：
Kelley, R;Duong, DH;Locke, GE
目的：用于缓解神经囊尾蚴病患者脑积水的脑室分流术一直受到高分流故障率的困扰。我们检查了神经囊尾蚴病患者分流故障的特征。方法：这是对 5.5 年期间 122 名被诊断为囊尾蚴病入院的患者的数据进行的回顾性图表审查。对需要放置分流器的脑积水病例进行了回顾，包括分流器梗阻的节段、分流器放置时的疾病活动性以及抗蠕虫治疗对分流器失败和寿命的影响。 结果：21 名患者需要 49 次手术来缓解脑积水，其中包括 22 例新的分流器放置、23 例翻修和 4 例囊肿摘除术。在这些分流故障中，78% 发生在前 12 个月内，96% 发生在 3 年内。在远端段发生的故障中，75% 发生在 6 个月内。相比之下，近端段梗阻的 33% 和瓣膜梗阻总数的 50% 发生在前 6 个月内。在感染水泡阶段放置的分流器中，63% 需要修复，而在胶体阶段至钙化阶段放置的分流器中，这一比例为 29%。在水疱期放置了 19 例分流器，9 名患者在分流器放置后接受了全程抗蠕虫治疗。在不到 6 个月的时间里，33% 的分流器放置后接受抗蠕虫治疗的病例出现分流失败，而未接受抗蠕虫治疗的病例中有 90% 出现分流失败（P < 0.05，检验）。结论：在水泡期囊尾蚴病患者中，放置脑室腹腔分流器并随后接受一个疗程的抗蠕虫药物治疗似乎可以延长分流器的寿命。
OBJECTIVE: Ventricular shunts used to relieve hydrocephalus among patients with neurocysticercosis have been plagued by high shunt malfunction rates. We examined the characteristics of shunt malfunctions among patients with neurocysticercosis.METHODS: This is a retrospective chart review of data for 122 patients who were admitted with a diagnosis of cysticercosis during a 5.5-year period. Cases of hydrocephalus requiring shunt placement were reviewed with respect to the segment of shunt obstruction, disease activity at the time of shunt placement, and the effects of antihelminthic treatment on shunt failures and longevity.RESULTS: Twenty-one patients required 49 operations for relief of hydrocephalus, including 22 new shunt placements, 23 revisions, and 4 cyst extirpations. Of these shunt failures, 78% occurred within the first 12 months and 96% within 3 years. Of the failures that occurred in the distal segment, 75% occurred within 6 months. By comparison, 33% of proximal segment obstructions and 50% of the total number of valve obstructions occurred within the first 6 months. Of the shunts placed during the vesicular stage of infection, 63% required revisions, compared with 29% of those placed during the colloidal through calcified stages. Nineteen shunts were placed during the vesicular stage, and nine patients received a full course of antihelminthic treatment after shunt placement. In less than 6 months, 33% of the cases involving shunt placement followed by antihelminthic treatment exhibited shunt failure, compared with 90% of the cases without antihelminthic treatment (P < 0.05, test).CONCLUSION: Among patients with vesicular stage cysticercosis, placement of a ventriculoperitoneal shunt followed by a course of antihelminthic medication seems to promote shunt longevity.