Sainz Laura V, Hockel Konstantin, Schuhmann Martin U
Division of Pediatric Neurosurgery, Department of Neurosurgery, Eberhard Karls University Hospital of Tübingen, Tübingen, Germany.
Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Childs Nerv Syst. 2018 Mar;34(3):401-408. doi: 10.1007/s00381-017-3650-4. Epub 2017 Nov 11.
Chronic overdrainage affects shunted patients producing a variety of symptoms that may be misdiagnosed. The best known symptoms are so-called shunt-related headaches. There is mounting evidence that changes in cerebrospinal venous system dynamics are a key factor to the pathophysiology of chronic overdrainage syndrome.
We report the case of a 29-year-old woman with a shunt since the postnatal period suffering from chronic but the most severe intermittent headache attacks, despite an open shunt and with unchanged ventricular width during attacks. Intracranial pressure (ICP) recordings were performed during headache attacks and thereafter.
Massively increased ICPs, a continuous B wave "storm," and severely compromised intracranial compliance despite an open shunt were found, a scenario that was always self-limiting with the resolution of symptoms after several hours. When mobilized to the upright position, her ICPs dropped to - 17 mm Hg, proving shunt overdrainage.
Symptomatology can only be explained by sudden venous entrapment following chronic venous distention as a result of chronic overdrainage. Subsequent therapeutic management with an overdrainage preventing shunt and satisfying clinical outcome with complete ceasing of headache attacks adds insight into the pathophysiology of chronic overdrainage syndrome.
慢性引流过度会影响接受分流术的患者，产生多种可能被误诊的症状。最常见的症状是所谓的分流相关性头痛。越来越多的证据表明，脑脊液静脉系统动力学的变化是慢性引流过度综合征病理生理学的关键因素。
我们报告一例29岁女性病例，自出生后即接受分流术，尽管分流管通畅且发作期间脑室宽度未变，但仍患有慢性且最严重的间歇性头痛发作。在头痛发作期间及之后进行了颅内压（ICP）记录。
尽管分流管通畅，但发现颅内压大幅升高、持续的B波“风暴”以及颅内顺应性严重受损，这种情况总是在数小时后症状缓解时自我限制。当她站立时，颅内压降至-17 mmHg，证明存在分流过度引流。
症状只能用慢性引流过度导致慢性静脉扩张后突然的静脉受压来解释。随后采用防止过度引流的分流管进行治疗管理，并取得了头痛发作完全停止的满意临床结果，这为慢性引流过度综合征的病理生理学提供了深入了解。
