感染后脑积水合并多发脑室分隔的手术治疗结果

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2023-11-14 DOI:10.1186/s41984-023-00245-6
Mohamed Mohsen Amen, Mohamed Badran, Ahmed Zaher, Amr Farid Khalil, Ibrahim Abdelaal, Mahmoud Saad
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Bacterial meningitis was the most common cause of hydrocephalus with multiple intraventricular septations in 37 patients (48.6%), while 24 patients had post-shunt infection (31.6%) that was complicated with multiloculated hydrocephalus. After confirming clearance of CSF infection, all patients underwent ventriculoscopic cyst fenestration and insertion of a ventriculoperitoneal shunt to create a single communicating system drained by one ventricular catheter. Fifty-five patients underwent De novo shunt implantation, while 20 patients required shunt revision. Endoscopy reduced the shunt revision rate from 3.4 per year before fenestration to 0.4 per year after fenestration. During the mean follow-up period of 7.7 months (range: 1–20 months), complications were reported in 13 patients (17.1%), including CSF leakage in eight (10.5%), VPS malfunction in five (6.5%), and two deaths (2.6%). 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摘要

摘要目的感染后脑积水合并多发脑室分隔是神经外科的一个复杂问题,有多种治疗选择。作者回顾了神经内窥镜囊肿壁开窗治疗这种疾病的结果。材料与方法收集76例经内镜治疗的感染后脑积水合并多发性脑室隔的病历资料进行分析。结果本组患者男性40例(52.6%),女性36例(47.4%),平均年龄22.36个月(范围:4 ~ 132个月)。细菌性脑膜炎是脑积水合并多发性脑室分隔最常见的原因,37例(48.6%),24例(31.6%)有分流后感染合并多房性脑积水。在确认脑脊液感染清除后,所有患者均行脑室镜下囊肿开窗术,并插入脑室-腹膜分流术,以建立一个由一根脑室导管引流的单一通信系统。55例患者接受了重新植入分流器,20例患者需要分流器翻修。内窥镜检查将分流翻修率从开窗前的每年3.4降低到开窗后的每年0.4。在平均7.7个月(1-20个月)的随访期间,13例(17.1%)患者出现并发症,包括8例脑脊液漏(10.5%),5例VPS功能障碍(6.5%),2例死亡(2.6%)。结论神经内窥镜开窗配合脑室导管引流脑脊液是治疗多室感染后脑积水的有效方法,其发病率和死亡率均低于传统方法。
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The outcome of surgical management of post-infectious hydrocephalus with multiple intraventricular septations
Abstract Objectives Post-infection hydrocephalus with multiple intraventricular septations is a complex issue in neurosurgery, with multiple treatment options available. The authors reviewed the results of neuroendoscopic cyst wall fenestration for managing this disease. Materials and Methods Medical records of 76 patients with post-infection hydrocephalus and multiple intraventricular septations who underwent endoscopic treatment were collected and analyzed. Results The patient group consisted of 40 males (52.6%) and 36 females (47.4%), with a mean age of 22.36 months (range: 4–132 months). Bacterial meningitis was the most common cause of hydrocephalus with multiple intraventricular septations in 37 patients (48.6%), while 24 patients had post-shunt infection (31.6%) that was complicated with multiloculated hydrocephalus. After confirming clearance of CSF infection, all patients underwent ventriculoscopic cyst fenestration and insertion of a ventriculoperitoneal shunt to create a single communicating system drained by one ventricular catheter. Fifty-five patients underwent De novo shunt implantation, while 20 patients required shunt revision. Endoscopy reduced the shunt revision rate from 3.4 per year before fenestration to 0.4 per year after fenestration. During the mean follow-up period of 7.7 months (range: 1–20 months), complications were reported in 13 patients (17.1%), including CSF leakage in eight (10.5%), VPS malfunction in five (6.5%), and two deaths (2.6%). Conclusion The authors concluded that neuroendoscopic fenestration with the aid of CSF drainage by intraventricular catheter is an effective treatment for managing multiloculated post-infection hydrocephalus with much lower rates of morbidity and mortality than traditional procedures.
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