Lin Jian, Zhang Nu, Sheng Hang-song, Wang Mao-de, Yin Bo, Lin Fen-chun
Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, PR China.
Pediatr Neurosurg. 2011;47(2):108-12. doi: 10.1159/000330540. Epub 2011 Sep 2.
Ventriculoperitoneal shunting is the current mainstay of treatment for children with tuberculous meningitis with hydrocephalus. However, ventriculoperitoneal shunting is highly associated with complications, and more importantly, long-term, indwelling shunt devices may adversely affect children's spirits and psychological health. Therefore, there is clearly a need to explore methods of CSF diversion to avoid ventriculoperitoneal shunting.
We studied 6 cases of children with tuberculous meningitis with hydrocephalus in whom external drainage from the ventricle to the subcutaneous abdomen was adopted. Outcomes were assessed over a 6- to 9-month follow-up period based on improvements in radiological features, such as ventricular morphology, as well as the need for ventriculoperitoneal shunting and any complications.
The drainage tubes were removed in 4 cases 4-6 months after the modified external ventricular drainage surgery, and 2 patients went on to receive a ventriculoperitoneal shunt. All patients' CSF protein and cell counts returned to normal, and imaging showed improved ventricular morphology and no intracranial secondary infection.
In our preliminary study, the modified ventricular drainage device can produce satisfactory outcomes and relatively safe effects and may help some patients to avoid ventriculoperitoneal shunt placement.
脑室腹腔分流术是目前结核性脑膜炎合并脑积水患儿的主要治疗方法。然而，脑室腹腔分流术与并发症高度相关，更重要的是，长期留置分流装置可能对患儿的精神和心理健康产生不利影响。因此，显然有必要探索脑脊液分流方法以避免脑室腹腔分流术。
我们研究了6例结核性脑膜炎合并脑积水的患儿，采用了从脑室到皮下腹部的外引流术。在6至9个月的随访期内，根据影像学特征（如脑室形态）的改善情况、脑室腹腔分流术的需求以及任何并发症来评估结果。
4例患者在改良脑室体外引流术后4至6个月拔除引流管，2例患者继续接受脑室腹腔分流术。所有患者的脑脊液蛋白和细胞计数恢复正常，影像学显示脑室形态改善且无颅内继发感染。
在我们的初步研究中，改良脑室引流装置可产生满意的结果和相对安全的效果，并可能帮助一些患者避免进行脑室腹腔分流术。
