成人腹膜下分流术后的临床和影像学结果。

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Neurology and Neurosurgery Pub Date : 2024-10-22 DOI:10.1016/j.clineuro.2024.108613
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引用次数: 0

摘要

背景:硬膜下积液主要包括脑脊液、炎性积液、出血性积液或感染性积液。虽然这些积液可通过保守或手术措施治疗,如钻孔抽液或开颅手术,但由于其复发率较高,临床医生可能会采用植入腹膜下分流术。虽然这种治疗方法在儿科人群中广泛使用,但其在成人中的疗效和安全性却鲜有报道:该项目是一项回顾性病例系列研究,共收集了 25 例在 2008 年 12 月至 2021 年 6 月间接受腹膜下分流术(SDPS)的成人患者。适应症包括外伤、肿瘤切除术或骨瓣再植术后出现的无症状硬膜下积液。一般情况下,均使用可调节瓣膜。所有患者都接受了术前和术后计算机断层扫描(CT)。我们评估了患者的术后临床疗效以及放射学标准,包括中线移位、额角宽度和收集体积。此外,我们还分析了与分流相关的并发症:结果:意识障碍是最常见的症状。我们报告称,SDP 分流术后硬膜下积液的体积和宽度明显缩小。此外,中线移位也明显减少。60%(15 人)的患者临床症状有所改善,只有 12%(3 人)的患者病情恶化。并发症包括12%的患者(3例)出现感染,1例患者出现瓣膜功能障碍:我们的研究表明,成人 SDPS 是消除或减少硬膜下积液的有效治疗方法,能改善大多数患者的临床疗效。因此,应该在这一患者群体中更广泛地使用。不过,还需要进一步的研究来验证这种治疗方法,并确定符合条件的患者。
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Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults

Background

Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.

Methods

This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients’ postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.

Results

Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.

Conclusions

Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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