Misaki Kouichi, Uchiyama Naoyuki, Hayashi Yutaka, Hamada Jun-ichiro
Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Neurol Med Chir (Tokyo). 2010 Jan;50(1):76-9. doi: 10.2176/nmc.50.76.
Four patients presented with intracerebral hemorrhage secondary to ventriculoperitoneal (VP) shunt insertion. VP shunt insertion was performed for idiopathic normal-pressure hydrocephalus (Case 1), hydrocephalus after cerebellar hemorrhage (Case 2), and subarachnoid hemorrhage followed by meningitis (Cases 3 and 4). Cerebral hemorrhage was confirmed 4 hours (Case 1), 2 days (Case 2), 7 days (Case 3), and 13 days (Case 4) after the operation. Cases 1 and 2 required intraoperative hemostasis for bleeding from the cortical vein. The 7 previous and our 4 patients were divided according to early (within 2 days after shunt placement, n = 6, Group 1) and delayed (5-13 days post-shunting, n = 5, Group 2) hemorrhage. Bleeding was attributable to venous occlusion due to intraoperative manipulation in Group 1, and to the vulnerability of brain tissue induced by a primary brain disease in Group 2.
4例患者在脑室腹腔（VP）分流术后出现脑出血。VP分流术用于治疗特发性正常压力脑积水（病例1）、小脑出血后脑积水（病例2）以及蛛网膜下腔出血后继发脑膜炎（病例3和病例4）。脑出血分别在术后4小时（病例1）、2天（病例2）、7天（病例3）和13天（病例4）得到确诊。病例1和病例2因皮质静脉出血在术中需要止血。将之前的7例患者和我们的4例患者根据早期（分流放置后2天内，n = 6，第1组）和延迟性（分流术后5 - 13天，n = 5，第2组）出血进行分组。第1组出血归因于术中操作导致的静脉闭塞，第2组出血归因于原发性脑疾病引起的脑组织脆弱性。
