Guo Xinxia, Popal Abdul Malik, Zhu Zhoule, Cai Chengwei, Lin Jingquan, Jiang Hongjie, Zheng Zhe, Zhang Jianmin, Shao Anwen, Zhu Junming
Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Surg. 2021 Aug 23;8:607417. doi: 10.3389/fsurg.2021.607417. eCollection 2021.
Conventional corticospinal fluid (CSF) diversion surgery for idiopathic normal pressure hydrocephalus (iNPH) includes ventriculoperitoneal shunt and ventriculoatrial shunt. Ventriculosternal (VS) shunt may be considered if both the abdominal cavity and atrium are not feasible. A 76-year-old woman was admitted to our hospital with gait disturbance and urinary incontinence for 2 years, and the condition aggravated in the last 1 month. Based on clinical assessment and imaging findings, the patient was diagnosed with iNPH, with surgical indications. She was on peritoneal dialysis for chronic renal failure, and a cardiac Doppler echocardiogram showed enlargement of the left atrium and decreased diastolic function of the left ventricle. Due to these conditions, we chose the sternum as the vessel for CSF absorption and performed VS shunt. No swelling, exudation, and effusion were found in the suprasternal fossa. Gait disturbance and urinary incontinence improved significantly immediately and 1 week after surgery, respectively. No shunt-related complication was reported at 16 months follow-up. This case demonstrated VS shunting as a feasible and alternative for the management of hydrocephalus.
特发性正常压力脑积水（iNPH）的传统脑脊液（CSF）分流手术包括脑室腹腔分流术和脑室心房分流术。如果腹腔和心房均不可行，则可考虑行脑室胸骨（VS）分流术。一名76岁女性因步态障碍和尿失禁2年入院，近1个月病情加重。根据临床评估和影像学检查结果，该患者被诊断为iNPH，具有手术指征。她因慢性肾衰竭正在进行腹膜透析，心脏多普勒超声心动图显示左心房扩大，左心室舒张功能减退。由于这些情况，我们选择胸骨作为脑脊液吸收的血管并进行了VS分流术。胸骨上窝未发现肿胀、渗出和积液。步态障碍和尿失禁分别在术后即刻和术后1周明显改善。随访16个月未报告与分流相关的并发症。该病例表明VS分流术是治疗脑积水的一种可行替代方法。
