Department of Pediatrics, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan.
J Clin Neurosci. 2010 May;17(5):658-61. doi: 10.1016/j.jocn.2009.07.122. Epub 2010 Mar 4.
Cerebrospinal fluid (CSF) edema and porencephaly are rare postoperative complications of a ventricular shunt that result from obstruction of the distal catheter, especially in children with taut ventricles. We report a 10-year-old male with cerebellar germinoma complicated by obstructive hydrocephalus. Ventriculopuncture was performed and an Ommaya reservoir was implanted at the right frontal horn. A distal catheter was initially attached to the reservoir for drainage of hydrocephalus but was later removed. After surgery, multi-agent chemotherapy and radiation therapy, a brain MRI showed CSF edema and porencephaly in the right frontal white matter. These lesions were reduced by prompt removal of the ventricular catheter. It is important to recognize such complications and to remove the catheter as soon as possible, because the brain tissue affected by massive edema may develop irreversible changes. Advanced MRI techniques, including fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging may be helpful for assessing this pathological condition and its prognosis.
脑积水分流术后并发脑积水肿和脑穿通畸形较为罕见，其原因多为远端引流管堵塞，尤其在脑室张力较高的儿童中更为常见。我们报道了 1 例 10 岁男性小脑生殖细胞瘤并发梗阻性脑积水。行脑室穿刺并在右额角植入 Ommaya 储液囊，最初将远端引流管与储液囊相连以引流脑积水，但后来将其移除。术后行多药化疗和放疗，头颅 MRI 显示右侧额白质存在脑积水肿和脑穿通畸形。及时移除脑室引流管后，这些病变有所减轻。重要的是要认识到这种并发症，并尽快移除导管，因为受大量水肿影响的脑组织可能会发生不可逆转的变化。先进的 MRI 技术，包括液体衰减反转恢复（FLAIR）和弥散加权成像（DWI），可能有助于评估这种病理状况及其预后。
