Kelley Rosemarie, Duong Duc H, Locke George E
Department of Neuroscience, Kenneth Hahn Comprehensive Stroke and Epilepsy Center, Martin Luther King, Jr./Charles R. Drew Medical Center, Los Angeles, California 90059, USA.
Neurosurgery. 2002 Apr;50(4):757-61; discussion 761-2. doi: 10.1097/00006123-200204000-00014.
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.
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.
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, chi(2) test).
Among patients with vesicular stage cysticercosis, placement of a ventriculoperitoneal shunt followed by a course of antihelminthic medication seems to promote shunt longevity.
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发生率的困扰。我们研究了神经囊尾蚴病患者分流故障的特征。
这是一项对122例在5.5年期间被诊断为囊尾蚴病的患者的数据进行的回顾性图表审查。对需要进行分流置管的脑积水病例，就分流梗阻部位、分流置管时的疾病活动情况以及抗蠕虫治疗对分流失败和使用寿命的影响进行了审查。
21例患者因脑积水需要进行49次手术，包括22次新的分流置管、23次翻修和4次囊肿摘除。在这些分流失败病例中，78%发生在最初12个月内，96%发生在3年内。在远端节段发生的失败中，75%发生在6个月内。相比之下，近端节段梗阻的33%和瓣膜梗阻总数的50%发生在最初6个月内。在感染的囊泡期放置的分流管中，63%需要翻修，而在胶体期至钙化期放置的分流管中这一比例为29%。在囊泡期放置了19根分流管，9例患者在分流置管后接受了全程抗蠕虫治疗。在不到6个月的时间里，接受抗蠕虫治疗后进行分流置管的病例中有33%出现分流失败，而未接受抗蠕虫治疗的病例中这一比例为90%（P<0.05，卡方检验）。
在囊泡期囊尾蚴病患者中，先进行脑室腹腔分流术，然后进行一个疗程的抗蠕虫药物治疗似乎可延长分流管使用寿命。
