Latyshev Ya A, Kravchuk A D, Likhterman L B, Zakharova N E, Zaytsev O S, Gavrilov A G, Okhlopkov V A, Potapov A A
Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(3):81-87. doi: 10.17116/neiro201882381.
One of the frequent consequences of severe traumatic brain injury is posttraumatic hydrocephalus that not only hampers the processes of consciousness recovery, rehabilitation, and social adaptation of patients but also is the cause of disability. Pathological processes underlying the clinical picture of posttraumatic hydrocephalus and the relationship between CSF circulation disorders and structural changes in the brain substance have not been adequately studied. Of particular importance are patients in the chronic vegetative or minimally conscious state, recovery from which is blocked by posttraumatic hydrocephalus. The question of reversibility of impaired consciousness depending on the disease duration has remained open. High risks of purulent-inflammatory complications of shunting surgery are especially important in patients with chronic infection foci (tracheostomy, gastrostomy, epicystostomy, prolonged bladder catheterization, pressure ulcers, etc.), but their actual effect on the shunting outcomes has not been revealed. Posttraumatic hydrocephalus remains a topical neurosurgical problem requiring clarification of its diagnostic criteria, differentiation from atrophy-related ventriculomegaly, and comprehensive development of pathogenetic and therapeutic aspects.
重型颅脑损伤的常见后果之一是创伤后脑积水,它不仅妨碍患者意识恢复、康复及社会适应进程,还是致残原因。创伤后脑积水临床表现背后的病理过程以及脑脊液循环障碍与脑实质结构变化之间的关系尚未得到充分研究。对于处于慢性植物状态或最低意识状态的患者尤为重要,创伤后脑积水阻碍了他们的恢复。意识障碍的可逆性取决于疾病持续时间这一问题仍未解决。在患有慢性感染灶(气管造口术、胃造口术、膀胱造瘘术、长期膀胱插管、压疮等)的患者中,分流手术发生化脓性炎症并发症的高风险尤为重要,但尚未揭示其对分流结果的实际影响。创伤后脑积水仍然是一个热门的神经外科问题,需要明确其诊断标准,与萎缩相关的脑室扩大相鉴别,并全面发展发病机制和治疗方面的研究。