Kraemer Mark R, Sandoval-Garcia Carolina, Bragg Taryn, Iskandar Bermans J
Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin.
J Neurosurg Pediatr. 2017 Sep;20(3):216-224. doi: 10.3171/2017.2.PEDS16265. Epub 2017 Jun 30.
OBJECTIVE The authors conducted a survey to evaluate differences in the understanding and management of shunt-dependent hydrocephalus among members of the American Society of Pediatric Neurosurgeons (ASPN). METHODS Surveys were sent to all 204 active ASPN members in September 2014. One hundred thirty responses were received, representing a 64% response rate. Respondents were asked 13 multiple-choice and free-response questions regarding 4 fundamental problems encountered in shunted-hydrocephalus management: shunt malfunction, chronic cerebrospinal fluid (CSF) overdrainage, chronic headaches, and slit ventricle syndrome (SVS). RESULTS Respondents agreed that shunt malfunction occurs most often as the result of ventricular catheter obstruction. Despite contrary evidence in the literature, most respondents (66%) also believed that choroid plexus is the tissue most often found in obstructed proximal catheters. However, free-text responses revealed that the respondents' understanding of the underlying pathophysiology of shunt obstruction was highly variable and included growth, migration, or adherence of choroid plexus, CSF debris, catheter position, inflammatory processes, and CSF overdrainage. Most respondents considered chronic CSF overdrainage to be a rare complication of shunting in their practice and reported wide variation in treatment protocols. Moreover, despite a lack of evidence in the literature, most respondents attributed chronic headaches in shunt patients to medical reasons (for example, migraines, tension). Accordingly, most respondents managed headaches with reassurance and/or referral to pain clinics. Lastly, there were variable opinions on the etiology of slit ventricle syndrome (SVS), which included early shunting, chronic overdrainage, and/or loss of brain compliance. Beyond shunt revision, respondents reported divergent SVS treatment preferences. CONCLUSIONS The survey shows that there is wide variability in the understanding and management of shunt-dependent hydrocephalus and its complications. Such discrepancies appear to be derived partly from inconsistent familiarity with existing literature but especially from a paucity of high-quality publications.
目的 作者开展了一项调查，以评估美国小儿神经外科学会（ASPN）成员在依赖分流的脑积水的认识和管理方面的差异。方法 2014年9月，向所有204名ASPN活跃成员发送了调查问卷。共收到130份回复，回复率为64%。就分流性脑积水管理中遇到的4个基本问题，向受访者提出了13个多项选择题和自由回答问题：分流故障、慢性脑脊液（CSF）过度引流、慢性头痛和裂隙脑室综合征（SVS）。结果 受访者一致认为，分流故障最常因脑室导管阻塞所致。尽管文献中有相反证据，但大多数受访者（66%）也认为脉络丛是阻塞近端导管中最常发现的组织。然而，自由文本回复显示，受访者对分流阻塞潜在病理生理学的理解差异很大，包括脉络丛生长、迁移或粘连、CSF碎片、导管位置、炎症过程和CSF过度引流。大多数受访者认为慢性CSF过度引流在他们的实践中是分流的罕见并发症，并报告治疗方案差异很大。此外，尽管文献中缺乏证据，但大多数受访者将分流患者的慢性头痛归因于医学原因（如偏头痛、紧张性头痛）。因此，大多数受访者通过安慰和/或转诊至疼痛诊所来处理头痛。最后，关于裂隙脑室综合征（SVS）的病因存在不同观点，包括早期分流、慢性过度引流和/或脑顺应性丧失。除了分流修复外，受访者报告了不同的SVS治疗偏好。结论 该调查显示，在依赖分流的脑积水及其并发症的认识和管理方面存在很大差异。这种差异部分似乎源于对现有文献的熟悉程度不一致，但特别是源于高质量出版物的匮乏。
