Lai Lawrence P, Egnor Michael R, Carrion Wesley V, Haralabatos Susan S, Wingate Michael T
Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 90 Bergen St., Suite 3200, Newark, NJ 07103, USA.
Department of Neurosurgery, Stony Brook University, 24 Research Way, Suite 200, Stony Brook, NY 11794, USA.
Spine J. 2014 Nov 1;14(11):e5-8. doi: 10.1016/j.spinee.2014.08.448. Epub 2014 Sep 6.
Two of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.
To report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.
Three case studies from a university hospital setting were included.
All three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.
Malfunctioning of the ventriculoperitoneal shunts were recorded.
Chart reviews of three cases were analyzed.
Two children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.
Older children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk.
儿童脑积水最常见的两种疾病过程是脊柱裂和早产儿脑室内出血，已知这两种疾病在儿童后期也与脊柱畸形有关。机械损伤或硬件受压后分流器故障的发生已有充分记录。治疗神经肌肉型脊柱侧凸的新技术，包括前路松解联合节段性固定，已能更有效地矫正这些严重的脊柱畸形。脊柱侧凸的积极矫正可能是分流器故障的一个新原因。
报告平均侧弯角度为100°的神经肌肉型脊柱侧弯患者，这些患者随后被发现存在围手术期分流器故障。
纳入了来自大学医院的三个病例研究。
所有三个儿童均为青少年，且长期使用分流器。其中两个儿童患有脊柱裂，第三个患有脑瘫。所有儿童均接受了脊柱侧弯前路松解联合后路节段性器械固定术，使用单元棒和椎板下钢丝。所有患者的脊柱侧弯均得到了显著矫正。
记录脑室腹腔分流器的故障情况。
对三个病例的病历进行分析。
两名儿童在术后一个月内出现分流器故障，一名儿童在术中发现分流器并将其外置。
接受神经肌肉型脊柱侧弯修复手术的大龄儿童通常是青春期前或青少年，他们最初在婴儿早期植入的分流系统仍在体内。分流器可能变脆并钙化，腹膜导管可能较短。脊柱侧弯的矫正通常会导致身高几乎瞬间增长几英寸。由于围手术期识别分流器故障存在潜在困难，对于有风险的儿童，应考虑择期更换腹膜导管。
