Missori Paolo, Miscusi Massimo, Formisano Rita, Peschillo Simone, Polli Filippo M, Melone Antonio, Martini Stefano, Paolini Sergio, Delfini Roberto
Department of Neurosciences, Neurosurgery and Neuroradiology, University of Rome "La Sapienza", Fondazione Santa Lucia IRCSS, Rome, Italy.
Neurosurg Rev. 2006 Jul;29(3):224-8. doi: 10.1007/s10143-006-0027-7. Epub 2006 May 31.
The assessment of the flow-void in the cerebral aqueduct of patients with post-traumatic hydrocephalus on magnetic resonance imaging (MRI) evaluation could concur the right diagnosis and have a prognostic value. We analysed prospectively 28 patients after a severe head injury (GCS<or=8), with radiological or clinical suspicion of post-traumatic hydrocephalus and a fast flow-void signal in the cerebral acqueduct on T2-weighted and proton density MRI. Twenty-two patients were shunted (n=19) or revised (n=3). Six patients were followed-up without surgery. Twenty out of 22 shunted patients (91%) showed variable reduction of the fast flow-void. Eighteen of the operated patients (82%) presented a significant clinical improvement at 6-month follow-up. All patients (n=2) who had no change of the fast flow-void after surgery did not clinically improve. The six non-shunted patients did not present any clinical or radiological improvement. In head-injured patients, fast flow-void in the cerebral aqueduct is diagnostic for post-traumatic hydrocephalus and its reduction after ventriculo-peritoneal shunt is correlated with a neurological improvement. In already shunted patients, a persistent fast flow-void is associated with a lack of or very slow clinical improvement and it should be considered indicative of under-drainage.
在磁共振成像（MRI）评估中，对创伤后脑积水患者中脑导水管流空现象的评估有助于做出正确诊断并具有预后价值。我们前瞻性分析了28例重度颅脑损伤（格拉斯哥昏迷评分≤8分）患者，这些患者有创伤后脑积水的影像学或临床怀疑，且在T2加权和质子密度MRI上中脑导水管有快速流空信号。22例患者接受了分流手术（n = 19）或修复手术（n = 3）。6例患者未手术进行随访。22例分流患者中有20例（91%）快速流空现象有不同程度减轻。18例手术患者（82%）在6个月随访时临床症状有显著改善。术后快速流空现象无变化的所有患者（n = 2）临床症状均未改善。6例未分流患者在临床和影像学上均无改善。在颅脑损伤患者中，中脑导水管快速流空现象可诊断创伤后脑积水，脑室-腹腔分流术后其减轻与神经功能改善相关。在已分流患者中，持续存在的快速流空现象与临床改善缺乏或非常缓慢相关，应被视为引流不足的指征。
