Manet R, Schmidt E A, Vassal F, Charier D, Gergelé L
Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Étienne, France.
Service de neurochirurgie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint-Priest-en-Jarez, 42 270, France.
Acta Neurochir Suppl. 2016;122:55-9. doi: 10.1007/978-3-319-22533-3_11.
External lumbar drainage (ELD) of cerebrospinal fluid (CSF) in posttraumatic refractory intracranial hypertension (ICHT) is controversial. We report our experience of ELD in ICHT associated with acute disturbance of CSF flow within subarachnoid spaces (SASs).
Four adult patients admitted to the neurointensive care unit for severe TBI who presented with secondary ICHT are retrospectively reported. When refractory to second-tier therapy, if external ventricular drainage were not possible or failed, and in the absence of an indication for craniotomy to treat a mass lesion or decompressive craniectomy, we assessed the evolution of CSF volume within cranial SAS and checked the presence of basal cisterns and the absence of tonsillar herniation to evaluate interest in and the safety of ELD.
As second-tier therapy failed to lower intracranial pressure (ICP; mean ICP 37 ± 5 mmHg), and computed tomography (CT) showed abnormally enlarged cranial SAS following traumatic subarachnoid hemorrhage, patients received ELD. ICP decreased, with immediate and long-term effect (mean ICP 5 mmHg ± 2 mmHg). There were no complications to report.
Acute traumatic external hydrocephalus may explain some of the specific situations of secondary increased ICP, with a "normal" CT scan, that is refractory to medical treatment. In these situations, lumbar drainage should be considered to be a safe, minimally invasive, and effective surgical option.
创伤后难治性颅内高压（ICHT）患者行脑脊液（CSF）外引流（ELD）存在争议。我们报告了在蛛网膜下腔（SAS）内脑脊液流动急性紊乱相关的ICHT患者中进行ELD的经验。
回顾性报告4例因重度创伤性脑损伤（TBI）入住神经重症监护病房并出现继发性ICHT的成年患者。当二线治疗无效时，如果无法进行或进行脑室引流失败，且无开颅手术治疗占位性病变或减压性颅骨切除术的指征时，我们评估了颅内SAS内脑脊液量的变化，并检查基底池的情况以及有无小脑扁桃体疝，以评估ELD的可行性和安全性。
由于二线治疗未能降低颅内压（ICP；平均ICP为37±5mmHg），且计算机断层扫描（CT）显示创伤性蛛网膜下腔出血后颅内SAS异常扩大，患者接受了ELD。ICP降低，有即刻和长期效果（平均ICP为5mmHg±2mmHg）。无并发症报告。
急性创伤性外部脑积水可能解释了一些继发性ICP升高的特殊情况，即“正常”CT扫描且药物治疗无效的情况。在这些情况下，腰椎引流应被视为一种安全、微创且有效的手术选择。
