Kim Seung-Ki, Cho Byung-Kyu, Chung You-Nam, Kim Hee-Soo, Wang Kyu-Chang
Division of Pediatric Neurosurgery and Laboratory for Fetal Medicine Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Pediatr Neurosurg. 2002 Oct;37(4):178-85. doi: 10.1159/000065393.
Cystoperitoneal (CP) shunting is minimally invasive and achieves a high rate of resolution on neuroimaging. However, in the absence of definite symptoms, shunting should be reconsidered, because some patients can experience shunt dependency after CP shunting. In this study, the risk of shunt dependency in patients with arachnoid cysts treated with CP shunting and the management of these patients are described. Eight patients (7 boys and 1 girl) were diagnosed as shunt dependent following CP shunting. At the time of the first operation (mean age at first shunting 6.1 years, range 1-11 years), a causal relationship between symptoms and the arachnoid cyst was evident in only 2 cases. Clinical manifestations, neuroimaging (computed tomography and/or magnetic resonance imaging) and intracranial pressure (ICP) data were reviewed retrospectively. The mean age of the patients at the time of shunt dependency was 9.8 years (range 6-13 years), and the mean time between the first shunt operation and shunt dependency was 41 months (range 17-80 months). Although neuroimaging demonstrated a collapsed cyst and small ventricles in most patients, ICP monitoring revealed significant intracranial hypertension. The release of shunt ligation, revision or additional shunting, such as ventriculoperitoneal shunting or lumboperitoneal shunting, resulted in the complete resolution of symptoms except in one patient who lost vision. This study shows that shunt dependency after CP shunting is a real problem and requires more attention. ICP monitoring can demonstrate the presence of intracranial hypertension when clinical and radiological analyses do not.
囊肿 - 腹腔（CP）分流术是一种微创手术，在神经影像学上具有较高的治愈率。然而，在没有明确症状的情况下，应重新考虑分流术，因为一些患者在CP分流术后可能会出现分流依赖。在本研究中，描述了接受CP分流术治疗的蛛网膜囊肿患者发生分流依赖的风险以及对这些患者的管理。8例患者（7例男孩和1例女孩）在CP分流术后被诊断为分流依赖。在首次手术时（首次分流时的平均年龄为6.1岁，范围为1 - 11岁），仅2例患者的症状与蛛网膜囊肿之间存在明显的因果关系。对临床表现、神经影像学（计算机断层扫描和/或磁共振成像）和颅内压（ICP）数据进行了回顾性分析。患者出现分流依赖时的平均年龄为9.8岁（范围为6 - 13岁），首次分流手术至分流依赖的平均时间为41个月（范围为17 - 80个月）。尽管神经影像学显示大多数患者的囊肿塌陷且脑室较小，但ICP监测显示存在明显的颅内高压。解除分流结扎、进行分流术修正或额外的分流术，如脑室 - 腹腔分流术或腰 - 腹腔分流术，除1例失明患者外，其余患者症状均完全缓解。本研究表明，CP分流术后的分流依赖是一个实际问题，需要更多关注。当临床和放射学分析未显示时，ICP监测可显示颅内高压的存在。
