妊娠晚期内镜下第三脑室造瘘术治疗脑室腹腔分流术故障：病例说明
Endoscopic third ventriculostomy for VP shunt malfunction during the third trimester of pregnancy: illustrative case.
作者信息
Alhaj Ahmad K, Al-Saadi Tariq, Hébert-Blouin Marie-Noëlle, Petrecca Kevin, Dudley Roy W R
机构信息
Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait.
Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada; and.
出版信息
J Neurosurg Case Lessons. 2021 Jan 11;1(2):CASE2054. doi: 10.3171/CASE2054.
BACKGROUND
Endoscopic third ventriculostomy (ETV) is a successful procedure for treating noncommunicating hydrocephalus as an alternative to initial ventriculoperitoneal (VP) shunt placement and as a salvage procedure when a VP shunt fails. Physiological changes of pregnancy can lead to VP shunt failure and complicate the management of shunt malfunction, particularly in the third trimester.
OBSERVATIONS
The authors present a case in which an ETV was successfully used in the third trimester (31 weeks of gestation) of pregnancy for acute hydrocephalus due to VP shunt malfunction, and the patient went on to deliver a healthy baby at term; the patient remained well in the long-term follow-up. An English-language PubMed literature review revealed four cases of VP shunt failure successfully treated with an ETV in the first or second trimester but no such reports in the third trimester of pregnancy.
LESSONS
ETV appears to be a safe and effective alternative to VP shunt replacement in the late prenatal period of pregnancy.
背景
内镜下第三脑室造瘘术（ETV）是治疗非交通性脑积水的一种成功手术，可作为初始脑室腹腔（VP）分流术的替代方法，也可作为VP分流失败时的挽救手术。妊娠的生理变化可导致VP分流失败，并使分流故障的管理复杂化，尤其是在孕晚期。
观察结果
作者报告了一例病例，在妊娠晚期（妊娠31周）因VP分流故障导致急性脑积水，成功采用ETV治疗，患者足月分娩出一名健康婴儿；在长期随访中患者情况良好。对英文的PubMed文献进行回顾发现，有4例在孕早期或孕中期VP分流失败后采用ETV成功治疗的病例，但在妊娠晚期无此类报告。
经验教训
在妊娠晚期，ETV似乎是替代VP分流术的一种安全有效的方法。
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