Louzada Paulo Roberto, Requejo Paulo Roberto, Barroso Marcelo Viana, Vaitsman Rafael Pereira, Machado Alexandre Légora, Paiva Mauro Sérgio, Salame José Massoud
Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, RJ, Brazil.
Brain Inj. 2012;26(1):95-100. doi: 10.3109/02699052.2011.635356.
Ventricular over-drainage is a common complication of dysfunctional ventriculoperitoneal devices. Subdural haematomas are usually the most common lesions associated with that complication. Such lesions may arise after ventricular collapse and bridging veins disruption that follows over-drainage, thus contributing to distortion of brain parenchyma, increased intracranial hypertension and neurological decline. More rarely, extradural haematomas may also be observed after ventricular shunt hyperfunction and may result in rapid neurological decline unless a surgical procedure can be promptly performed.
This study reports the case of a 38-old-woman who presented supratentorial hydrocephalus and developed bilateral extradural haematomas after the placement of a ventricular shunt device. Both haematomas were surgically approached and the dysfunctional shunt device was replaced.
Extradural haematomas may develop precociously after ventricular over-drainage. Surgical treatment is mandatory and must include not only the evacuation of haematoma, but also the replacement of dysfunctional shunt to prevent further recurrence. The pathophysiology of extradural haematomas consequent of ventricular over-drainage and the possible use of a programmable valve to prevent these lesions are briefly discussed.
脑室过度引流是功能失调的脑室腹腔分流装置常见的并发症。硬膜下血肿通常是与该并发症相关的最常见病变。此类病变可能在脑室塌陷及过度引流后桥静脉破裂后出现，进而导致脑实质变形、颅内压升高及神经功能衰退。更罕见的是，脑室分流功能亢进后也可能观察到硬膜外血肿，若不及时进行手术，可能导致神经功能迅速衰退。
本研究报告了一名38岁女性患者的病例，该患者患有幕上脑积水，在植入脑室分流装置后出现双侧硬膜外血肿。对两个血肿均进行了手术处理，并更换了功能失调的分流装置。
脑室过度引流后可能过早出现硬膜外血肿。手术治疗是必要的，不仅要清除血肿，还必须更换功能失调的分流装置以防止进一步复发。本文简要讨论了脑室过度引流导致硬膜外血肿的病理生理学以及使用可编程瓣膜预防这些病变的可能性。
