脑室腹腔分流并发症患儿的神经影像学研究：德黑兰的一项10年描述性研究
The Neuroimaging Studies in Children with Ventriculoperitoneal Shunt Complications: A 10 Years Descriptive Sudy in Tehran.
作者信息
Shahi Mohammad Vafaee, Noorbakhsh Samileh, Zarrabi Vida, Nourozi Banafsheh, Tahernia Leila
机构信息
Pediatric Department, Pediatric growth and development research center, Institute of Endocrinology and Metabolism, University of Medical Sciences, Tehran, Iran.
Department of pediatric infectious diseases , University of Medical Sciences. Tehran, Iran.
出版信息
Open Neuroimag J. 2018 Jan 22;12:1-9. doi: 10.2174/1874440001812010001. eCollection 2018.
BACKGROUND
Any mismatch between the production and absorption of CSF results in hydrocephalus. In most cases, the selected choice of treatment is the ventriculoperitoneal shunt insertion. Although, the surgery could have complications such as infection, shunt malfunction, subdural hematoma, seizure and Shunt immigration; so, the early and proper detection of these complications could result in better prognosis. The aim of this study was to evaluate and compare the efficacy of CT scan, CSF analysis and X-ray radiography in detection of shunt complications and problems in shunt placement and further follow-up in hospitalized children.
METHODS
The medical records of children in Rasul Akram hospital in Tehran were reviewed retrospectively in the last 10 years, from 2006 to 2016. All data were recorded in the prepared form including the age, sex, shunt complication, CT scan and CSF characteristics.
RESULTS
The total number of 95 patients were interfered in this study including 56 males (58.9%) and 39 females (41.1%). The mean age at the onset of complications were 2.8±2.2 years-old. The shunt obstruction (60%) and infection (25.3%) were the most common complications. The CT scan was able to detect 36.5% of shunt complications. The CT scan had the sensitivity and specificity of 50 and 87%, respectively in detection of shunt obstruction. The all cases of brain hematoma and hemorrhage were revealed by CT scan. On the other hand, the CT scan had 20% of sensitivity and 60% of specificity in the detection of shunt infection. The CSF evaluation in shunt infection revealed 92% hypoglycemia, 87.5% pleocytosis, and 62.5% positive CSF culture. CSF had the sensitivity, specificity, positive predictive value and negative predictive value of 92, 82, 63 and 97%, respectively. The patient's symptoms and signs were helpful in obtaining higher test accuracy.
CONCLUSION
The CT scan was not a good sensitive and specific study in the detection of shunt obstruction and infection, but it was very accurate in detection of hemorrhage and hematoma. On the other hand, CSF evaluation was a reliable test in shunt infection disclosure.
背景
脑脊液生成与吸收之间的任何失衡都会导致脑积水。在大多数情况下，所选的治疗方法是脑室腹腔分流术。尽管如此，该手术可能会出现感染、分流管故障、硬膜下血肿、癫痫发作和分流管移位等并发症；因此，早期正确检测这些并发症可带来更好的预后。本研究的目的是评估和比较CT扫描、脑脊液分析和X线摄影在检测住院儿童分流并发症、分流管放置问题及后续随访中的效果。
方法
回顾性分析了2006年至2016年过去10年德黑兰拉苏尔·阿克拉姆医院儿童的病历。所有数据都记录在准备好的表格中，包括年龄、性别、分流并发症、CT扫描和脑脊液特征。
结果
本研究共纳入95例患者，其中男性56例（58.9%），女性39例（41.1%）。并发症发生时的平均年龄为2.8±2.2岁。分流管梗阻（60%）和感染（25.3%）是最常见的并发症。CT扫描能够检测出36.5%的分流并发症。CT扫描在检测分流管梗阻时的敏感性和特异性分别为50%和87%。所有脑血肿和出血病例均通过CT扫描发现。另一方面，CT扫描在检测分流管感染时的敏感性为20%，特异性为60%。分流管感染时的脑脊液评估显示92%低血糖、87.5%细胞增多和62.5%脑脊液培养阳性。脑脊液的敏感性、特异性、阳性预测值和阴性预测值分别为92%、82%、63%和97%。患者的症状和体征有助于提高检测准确性。
结论
CT扫描在检测分流管梗阻和感染方面并非灵敏且特异的检查，但在检测出血和血肿方面非常准确。另一方面，脑脊液评估是检测分流管感染的可靠检查。
Zotero 插件