Adib Sasan Darius, Hauser Till K, Engel Doortje C, Tatagiba Marcos, Skardelly Marco, Ramina Kristofer
Department of Neurosurgery, University of Tuebingen, Germany.
Department of Neuroradiology, University of Tuebingen, Germany.
World Neurosurg. 2018 Aug;116:274-278. doi: 10.1016/j.wneu.2018.05.175. Epub 2018 Jun 1.
Overshunting-associated myelopathy (OSAM) is a very rare complication of ventricular shunt therapy, and only 11 previous cases have been reported in the literature. We report the successful surgical management of a case of OSAM in a patient with bilateral jugular vein occlusion and congenital hydrocephalus.
A 45-year-old patient with shunt-dependent, congenital hydrocephalus presented to our department with an 8-year history of progressive tetraparesis and gait disturbance. The patient was wheelchair-dependent. A new magnetic resonance imaging scan of the head revealed slit ventricle syndrome and dural enhancement due to shunt overdrainage. Magnetic resonance imaging and a computed tomography-phlebography of the cervical spine revealed engorgement of the epidural venous plexus with secondary compression of the spinal cord and myelomalacia. Surgery was performed, during which we implanted a shunt valve. The patient recovered from surgery without any new deficits. The tetraparesis improved during the inpatient hospital stay. Computed tomography-phlebography was performed 5 days after surgery and showed that the epidural venous plexus anterior to the cervical spinal cord had returned to nearly normal size. On follow-up examination 3 months after surgery, the patient's strength had improved, and he was able to walk short distances with assistance and with ankle foot orthosis on the right side.
OSAM has to be considered according to the Monro-Kellie doctrine and is affected by an engorgement of the epidural cervical venous plexus, which can produce cervical myelopathy. Because it can be treated simply by increasing the shunt resistance, surgeons should be aware of the rarely detected overdrainage complication.
过度引流相关性脊髓病（OSAM）是脑室分流治疗中一种非常罕见的并发症，文献中仅报道过11例。我们报告了1例双侧颈静脉闭塞和先天性脑积水患者的OSAM成功手术治疗病例。
一名45岁依赖分流的先天性脑积水患者因进行性四肢瘫和步态障碍8年就诊于我院。患者需依赖轮椅。头部新的磁共振成像扫描显示裂隙脑室综合征和因分流过度引流导致的硬脑膜强化。颈椎磁共振成像和计算机断层静脉造影显示硬膜外静脉丛充血，继发脊髓受压和脊髓软化。进行了手术，术中植入了分流阀。患者术后恢复，未出现任何新的神经功能缺损。住院期间四肢瘫有所改善。术后5天进行计算机断层静脉造影，显示颈脊髓前方的硬膜外静脉丛已恢复至接近正常大小。术后3个月的随访检查显示，患者肌力有所改善，在右侧佩戴踝足矫形器并在他人协助下能够短距离行走。
根据孟罗 - 凯利学说，必须考虑OSAM，其受硬膜外颈静脉丛充血影响，可导致颈脊髓病。由于可通过增加分流阻力进行简单治疗，外科医生应意识到这种罕见的过度引流并发症。
