Petraglia Anthony L, Moravan Michael J, Dimopoulos Vassilios G, Silberstein Howard J
Department of Neurosurgery, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY 14642, USA.
Pediatr Neurosurg. 2011;47(2):99-107. doi: 10.1159/000330539. Epub 2011 Sep 13.
BACKGROUND/AIMS: Slit ventricles and multiple episodes of shunt failure are problematic in many infants and preterm neonates shunted for hydrocephalus. We utilized ventriculosubgaleal (VSG) shunting as the initial neurosurgical intervention in neonates with hydrocephalus associated with intraventricular hemorrhage and infants with myelomeningocele.
We conducted a chart review of 21 children initially treated with a VSG shunt between November 2002 and July 2009. Patient records and imaging studies were reviewed. Demographics, case data and clinical outcome were collected.
Five patients (27.8%) required a revision after conversion to a ventriculoperitoneal (VP) shunt. There were 9 cases of radiographic slit ventricles (45%). Average follow-up was 59.5 months (range 12-97 months). Average time interval to shunt conversion was 81.5 days. Two patients have not required conversion to a VP shunt (one with an 8-year follow-up). To date, none of these patients has required a subtemporal window or cranial vault expansion.
Based on our results, initial management of selected hydrocephalic infants with a VSG shunt may prove to be advantageous in the long run for these children as the number of shunt revisions and the incidence of slit ventricles are significantly less than those reported in the literature.
背景/目的：对于许多因脑积水而接受分流术的婴儿和早产新生儿来说，裂隙脑室和多次分流失败是个难题。我们采用脑室-帽状腱膜下（VSG）分流术作为患有与脑室内出血相关的脑积水的新生儿以及患有脊髓脊膜膨出的婴儿的初始神经外科干预措施。
我们对2002年11月至2009年7月期间最初接受VSG分流术治疗的21名儿童进行了病历回顾。对患者记录和影像学研究进行了审查。收集了人口统计学、病例数据和临床结果。
5名患者（27.8%）在转换为脑室-腹腔（VP）分流术后需要进行翻修。有9例影像学上的裂隙脑室（45%）。平均随访时间为59.5个月（范围12 - 97个月）。分流转换的平均时间间隔为81.5天。2名患者无需转换为VP分流术（其中1名患者随访了8年）。迄今为止，这些患者中没有一人需要颞下开窗或颅骨扩大术。
根据我们的结果，从长远来看，对于选定的脑积水婴儿，采用VSG分流术进行初始治疗可能对这些儿童有利，因为分流翻修的次数和裂隙脑室的发生率明显低于文献报道。
