Department of Interventional Neuroradiology, Clinical Institute ENERI, Buenos Aires, Argentina.
Clínica La Sagrada Familia, Buenos Aires, Argentina.
J Neurointerv Surg. 2022 May;14(5):495-9. doi: 10.1136/neurintsurg-2021-018136. Epub 2021 Dec 3.
Surgical ventriculoperitoneal shunting remains standard treatment for communicating hydrocephalus, despite persistently elevated infection and revision rates. A novel minimally invasive endovascular cerebrospinal fluid (CSF) shunt was developed to mimic the function of the arachnoid granulation which passively filters CSF from the central nervous system back into the intracranial venous sinus network. The endovascular shunt is deployed via a femoral transvenous approach across the dura mater into the cerebellopontine angle cistern. An octogenarian with intractable hydrocephalus following subarachnoid hemorrhage underwent successful endovascular shunting, resulting in swift intracranial pressure reduction from 38 to <20 cmHO (<90 min) and resolution of ventriculomegaly. This first successful development of a percutaneous transluminal venous access to the central nervous system offers a new pathway for non-invasive treatment of hydrocephalus and the potential for intervention against neurological disorders.
尽管感染率和返修率持续居高不下，外科脑室-腹腔分流术仍然是治疗交通性脑积水的标准方法。一种新型微创经血管内脑脊液（CSF）分流器被开发出来，以模拟蛛网膜颗粒的功能，蛛网膜颗粒将 CSF 从中枢神经系统被动过滤回颅内静脉窦网络。经血管内分流器通过股静脉经硬脑膜进入脑桥小脑角池。一名 80 多岁的蛛网膜下腔出血后难治性脑积水患者成功接受了经血管内分流术，颅内压迅速从 38 降至 <20 cmH2O（<90 分钟），脑室扩大得到缓解。这是首次成功开发出经皮经腔静脉进入中枢神经系统的方法，为非侵入性治疗脑积水提供了新途径，并有可能针对神经疾病进行干预。
