Hirsch J F
Service de Neurochirurgie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France.
Acta Neurochir (Wien). 1992;116(2-4):155-60. doi: 10.1007/BF01540869.
The treatment of hydrocephalus, over the centuries, underwent three stages of evolution. During antiquity, middle ages and Renaissance, hydrocephalus was not understood. Medical treatment was useless; surgery was hopeless. The second stage extends from the XIXth century to the end of the first half of the XXth century. CSF circulation was now understood; surgery however, remained inefficient, but some patients survived with arrested hydrocephalus. The third stage begins in the nineteen fifties with the development of silicone shunts with a valve. Surgery transforms the prognosis of hydrocephalus, but the number of post-operative complications creates new problems. The different attempts that have been made during these past two decades to solve these problems are reviewed. They have resulted in a reduction of the mechanical and infectious complications. CSF overdrainage has been minimized. Percutaneous ventriculo-cisternostomies have in some cases replaced shunts. In the future, to improve outcome in these hydrocephalics, surgery, when indicated, should be performed as early as possible. Knowledge and prevention of the causes of hydrocephalus should be developed.
几个世纪以来，脑积水的治疗经历了三个发展阶段。在古代、中世纪和文艺复兴时期，人们对脑积水并不了解。医学治疗毫无用处；手术也毫无希望。第二阶段从19世纪延伸至20世纪上半叶末。此时人们已经了解脑脊液循环；然而，手术仍然效果不佳，但一些患者的脑积水得到控制并存活下来。第三阶段始于20世纪50年代，随着带瓣膜的硅胶分流管的发展。手术改变了脑积水的预后，但术后并发症的数量又带来了新问题。本文回顾了过去二十年为解决这些问题所做的不同尝试。这些尝试减少了机械性和感染性并发症。脑脊液过度引流已降至最低限度。在某些情况下，经皮脑室 - 脑池造瘘术已取代分流术。未来，为改善这些脑积水患者的治疗效果，如有指征，手术应尽早进行。还应加强对脑积水病因的认识和预防。
