Nomura Sadahiro, Fujii Masami, Kajiwara Koji, Ishihara Hideyuki, Suehiro Eiichi, Goto Hisaharu, Suzuki Michiyasu
Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Childs Nerv Syst. 2010 Jul;26(7):931-5. doi: 10.1007/s00381-010-1092-3. Epub 2010 Feb 16.
Spinal canal stenosis (CS) occurs in patients with hydrocephalus who are treated with cerebrospinal fluid (CSF) shunting. The pathophysiology of CS comprises CSF overdrainage. We analyzed the incidence of CS and the factors causing it.
Thirty-three patients who underwent ventriculoperitoneal shunt during childhood visited the Outpatient Department in Yamaguchi University Hospital in 2006. Diameters of spinal canal at C(4) were measured. Treatment procedure, age, and type of hydrocephalus in the patients with CS were compared with those without CS.
Of the 33 patients, 10 (30.3%) presented CS, and two (6.1%) were symptomatic. A low-pressure valve caused CS with a significantly higher incidence than a medium- or high-pressure valve (60.0% vs. 17.4%, P < 0.05). Although the difference was not significant, the average age of shunt insertion for a patient with CS was slightly less (0.87 +/- 0.99) than for a patient without CS (1.63 +/- 1.58). No differences in the CS incidence were observed between obstructive and communicating hydrocephalus.
In order to prevent CS, the hydrocephalus should be appropriately controlled by using a medium- or high-pressure valve until the diameter of the spinal canal reaches the required level. Adjustment of the programmable valve with the patient's growth should be ideal.
脑积水患者接受脑脊液（CSF）分流治疗时会发生椎管狭窄（CS）。CS的病理生理学包括脑脊液过度引流。我们分析了CS的发生率及其成因。
2006年，33例童年期接受脑室腹腔分流术的患者就诊于山口大学医院门诊部。测量了第4颈椎水平的椎管直径。对发生CS的患者与未发生CS的患者的治疗过程、年龄和脑积水类型进行了比较。
33例患者中，10例（30.3%）出现CS，2例（6.1%）有症状。低压分流阀导致CS的发生率显著高于中压或高压分流阀（60.0%对17.4%，P<0.05）。虽然差异不显著，但发生CS的患者分流置入的平均年龄（0.87±0.99）略低于未发生CS的患者（1.63±1.58）。梗阻性脑积水和交通性脑积水的CS发生率没有差异。
为预防CS，在椎管直径达到所需水平之前，应使用中压或高压分流阀适当控制脑积水。随着患者生长对可编程分流阀进行调整应是理想的做法。
