Ono Kenichiro, Arimoto Hirohiko, Okawa Hidenori, Takahara Takashi, Kobayashi Hiroaki, Morinaga Yusuke
Department of Neurosurgery, Mishuku Hospital.
No Shinkei Geka. 2017 May;45(5):405-408. doi: 10.11477/mf.1436203522.
A 49-year-old woman suffered hydrocephalus after subarachnoid hemorrhage, and underwent a lumboperitoneal(LP)shunt operation. X-ray imaging revealed that a spinal catheter inserted into the cranial side from L2/3 turned caudally at the Th12 level. Postoperative numbness and pain of the left buttocks and posterior femoral region persisted. The spinal catheter was pulled about 5 cm to improve flexure, and was reconnected 10 months after the shunt procedure. Symptoms improved, but a similar symptom developed one and a half years later. The spinal catheter was torn at the connection to the shunt valve. The catheter curved to the left side of the spinal cord and the catheter tip was located around the right Th12/L1 intervertebral foramen. We continued observations with analgesics, but symptoms did not subside. The shunt was removed 16 months after symptom relapse, and symptoms disappeared immediately. Bent insertion of the lumbar catheter is a potential cause of lower limb neuropathy after LP shunt operation. Attention must also be paid to the continuity of the catheter in follow-up after shunt procedures.
一名49岁女性在蛛网膜下腔出血后出现脑积水，并接受了腰大池-腹腔（LP）分流手术。X线成像显示，从L2/3向颅侧插入的脊髓导管在胸12水平转向尾侧。术后左臀部和股后部持续存在麻木和疼痛。将脊髓导管拔出约5 cm以改善弯曲度，并在分流手术后10个月重新连接。症状有所改善，但一年半后出现了类似症状。脊髓导管在与分流阀的连接处撕裂。导管向脊髓左侧弯曲，导管尖端位于右胸12/腰1椎间孔周围。我们使用镇痛药继续观察，但症状并未消退。症状复发16个月后移除了分流装置，症状立即消失。腰导管弯曲插入是LP分流手术后下肢神经病变的一个潜在原因。在分流手术后的随访中，还必须注意导管的连续性。
