Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, Taiwan.
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Br J Neurosurg. 2023 Oct;37(5):963-966. doi: 10.1080/02688697.2018.1538481. Epub 2018 Dec 6.
Tonsillar herniation is a rare and seldom reported complication after lumboperitoneal (LP) shunting. There have been only few reports that have presented possible options for treatment with varying degrees of success. In this report, we describe a rare case of tonsillar herniation after LP shunting and review related literature.A 17-year-old girl with hydrocephalus related to a traumatic brain injury underwent implantation of an adjustable pressure shunt (valve setting2.5) and a small lumen peritoneal catheter via the L4-L5 interspinal space. One month later, she was admitted to the emergency room with a Glasgow Coma Scale score ofE1M1Vt and dilated pupil. Image studies demonstrated new-onset tonsillar herniation and a mild cervical syrinx. Emergent suboccipital decompressive craniectomy, C1 laminectomy, and duraplasty were performed. This was followed with ligation of the LP shunt and implantation of a ventriculoperitoneal (VP) shunt a few days later. The patient's Glasgow Coma Scale score gradually recovered to 6, which was her previous neurologic status.Tonsillar herniation as a complication after LP shunting is best treated with decompression, ligation or removal of the LP shunt, and a shift to a VP shunt. The tonsillar herniation should be rapidly addressed to avoid persistent symptoms or progression of the neurologic deficits.
扁桃体疝是腰椎-腹膜分流术后罕见且很少报道的并发症。仅有少数几篇报道提出了不同程度成功的治疗选择。在本报告中，我们描述了一例腰椎-腹膜分流术后罕见的扁桃体疝病例，并复习了相关文献。
一名 17 岁女孩因创伤性脑损伤相关脑积水行可调压分流阀（阀设置 2.5）和小口径腹膜导管植入术，通过 L4-L5 棘突间间隙。一个月后，她因格拉斯哥昏迷量表评分为 E1M1Vt 和瞳孔扩大而被收入急诊室。影像学研究显示新出现的扁桃体疝和轻度颈段脊髓空洞症。紧急行枕下减压颅骨切除术、C1 椎板切除术和硬脑膜成形术。几天后，结扎腰椎-腹膜分流管并植入脑室-腹膜分流管。患者的格拉斯哥昏迷量表评分逐渐恢复到 6，这是她之前的神经状态。
腰椎-腹膜分流术后出现扁桃体疝并发症，最好通过减压、结扎或移除腰椎-腹膜分流管，并转为脑室-腹膜分流管来治疗。应迅速解决扁桃体疝问题，以避免持续的症状或神经功能缺损的进展。
