负压性脑积水：一例双侧脑室腹腔分流术颅内压监测下成功治疗的病例报告

Negative-Pressure Hydrocephalus: A Case Report on Successful Treatment Under Intracranial Pressure Monitoring with Bilateral Ventriculoperitoneal Shunts.

作者信息

Pandey Sajan, Jin Yi, Gao Liang, Zhou Cheng Cheng, Cui Da Ming

机构信息

Department of Neurosurgery, Shanghai 10th affiliated hospital of Tongji University, Shanghai, P.R. China.

出版信息

World Neurosurg. 2017 Mar;99:812.e7-812.e12. doi: 10.1016/j.wneu.2016.12.049. Epub 2016 Dec 23.

DOI:10.1016/j.wneu.2016.12.049

PMID:28017745

Abstract

BACKGROUND

Negative-pressure hydrocephalus (NegPH), a very rare condition of unknown etiology and optimal treatment, usually presents postneurosurgery with clinical and imaging features of hydrocephalus, but with negative cerebrospinal fluid pressure.

CASE DESCRIPTION

We describe a NegPH case of -3 mm Hg intracranial pressure that was successfully treated to achieve 5 mm Hg under continuous intracranial pressure monitoring with horizontal positioning, head down and legs elevated to 10°-15°, neck wrapping for controlled venous drainage, chest and abdomen bandages, infusion of 5% dextrose fluid to lower plasma osmolarity (Na, 130-135 mmol/L), daily cerebrospinal fluid drainage >200 mL, and arterial blood gas partial pressure of carbon dioxide >40 mm Hg.

摘要

背景

负压性脑积水（NegPH）是一种病因不明且最佳治疗方法未知的极为罕见的病症，通常在神经外科手术后出现脑积水的临床和影像学特征，但脑脊液压力为阴性。

病例描述

我们描述了一例颅内压为-3 mmHg的负压性脑积水病例，通过持续颅内压监测，采取水平卧位、头低脚高10°-15°、颈部包扎以控制静脉引流、胸部和腹部包扎、输注5%葡萄糖液以降低血浆渗透压（钠，130-135 mmol/L）、每日脑脊液引流量>200 mL以及动脉血气二氧化碳分压>40 mmHg等措施，成功将颅内压治疗至5 mmHg。