Chen Qianwei, Feng Zhou, Tan Qiang, Guo Jing, Tang Jun, Tan Liang, Feng Hua, Chen Zhi
Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China; Department of Neurosurgery, The 211st Hospital of PLA, Harbin 150086, China.
J Neurol Sci. 2017 Apr 15;375:220-230. doi: 10.1016/j.jns.2017.01.072. Epub 2017 Feb 1.
Post-hemorrhagic hydrocephalus (PHH), also referred to as progressive ventricular dilatation, is caused by disturbances in cerebrospinal fluid (CSF) flow or absorption following hemorrhage in the brain. As one of the most serious complications of neonatal/adult intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), PHH is associated with increased morbidity and disability of these events. Common sequelae of PHH include neurocognitive impairment, motor dysfunction, and growth impairment. Non-surgical measures to reduce increased intracranial pressure (ICP) in PHH have shown little success and most patients will ultimately require surgical management, such as external ventricular drainage and shunting which mostly by inserting a CSF drainage shunt. Unfortunately, shunt complications are common and the optimum time for intervention is unclear. To date, there remains no comprehensive strategy for PHH management and it becomes imperative that to explore new therapeutic targets and methods for PHH. Over past decades, increasing evidence have indicated that hemorrhage-derived blood and subsequent metabolic products may play a key role in the development of IVH-, SAH- and TBI-associated PHH. Several intervention strategies have recently been evaluated and cross-referenced. In this review, we summarized and discussed the common aspects of hydrocephalus following IVH, SAH and TBI, relevant experimental animal models, clinical translation of in vivo experiments, and potential preventive and therapeutic targets for PHH.
出血后脑积水（PHH），也称为进行性脑室扩张，是由脑内出血后脑脊液（CSF）流动或吸收紊乱引起的。作为新生儿/成人脑室内出血（IVH）、蛛网膜下腔出血（SAH）和创伤性脑损伤（TBI）最严重的并发症之一，PHH与这些事件的发病率和残疾率增加相关。PHH的常见后遗症包括神经认知障碍、运动功能障碍和生长发育障碍。降低PHH患者颅内压（ICP）升高的非手术措施收效甚微，大多数患者最终需要手术治疗，如外部脑室引流和分流术，其中分流术主要是插入脑脊液引流分流管。不幸的是，分流并发症很常见，最佳干预时间尚不清楚。迄今为止，尚无针对PHH治疗的综合策略，因此探索PHH的新治疗靶点和方法势在必行。在过去几十年中，越来越多的证据表明，出血产生的血液及其后续代谢产物可能在IVH、SAH和TBI相关的PHH发展中起关键作用。最近对几种干预策略进行了评估和交叉参考。在本综述中，我们总结并讨论了IVH、SAH和TBI后脑积水的共同方面、相关实验动物模型、体内实验的临床转化以及PHH的潜在预防和治疗靶点。
