Neurosurgery Department, Mansoura University, Mansoura, Egypt.
Neurosurgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Childs Nerv Syst. 2022 Nov;38(11):2155-2162. doi: 10.1007/s00381-022-05661-x. Epub 2022 Oct 10.
The management of post-infectious hydrocephalus (PIH) remains challenging for neurosurgeons. It requires a temporary diversion procedure till the normalization of CSF parameters prior to the permanent one. Ventriculosubgaleal shunt (VSGS) was widely used in pediatric cases with post-hemorrhagic hydrocephalus (PHH). However, its role in PIH is still lacking. This study was done to elucidate the safety and efficacy of VSGS as a temporary CSF diversion procedure before the permanent one in patients with PIH.
This retrospective investigation analyzed the data of 50 consecutive cases who underwent VSGS for PIH.
The age of the included patients ranged between 1 and 10 months. Twenty-six cases had meningitis and or ventriculitis (52%), while the remaining had shunt infection. At follow-up, arresting of hydrocephalus was noted in ten patients (20%), while another 36 cases required the permanent diversion procedure within 35 days. Regarding the shunt complications, scalp infection, tissue breakdown, and shunt exposure were encountered in ten cases (20%), while CSF leakage was noted in 12 cases (24%). Shunt migration was noted in only two patients (4%). Shunt revision was needed in 16 cases (32%). Mortality was encountered in four cases (8%) because of sepsis. Risk factors for morbimortality included younger age, lower weight, male gender, and meningitis and or ventriculitis.
VSGS is a safe and effective procedure in infants awaiting definitive VPS for postinfectious hydrocephalus. It was proven that VSGS has shortened the hospital stay and the economic burden on the country.
对于神经外科医生来说， 感染后脑积水（PIH）的治疗仍然具有挑战性。 这需要在永久性分流术之前进行临时脑脊液分流术， 直到 CSF 参数恢复正常。 脑室-皮下分流术（VSGS）广泛应用于出血后脑积水（PHH）的儿科病例中。 然而，其在 PIH 中的作用仍不明确。 本研究旨在阐明 VSGS 作为 PIH 患者永久性分流术之前的临时 CSF 分流术的安全性和有效性。
本回顾性研究分析了 50 例连续接受 VSGS 治疗 PIH 的患者数据。
纳入患者的年龄在 1 至 10 个月之间。26 例（52%）患有脑膜炎和/或脑室炎， 其余患者则患有分流感染。 在随访中， 10 例（20%）患者脑积水停止进展， 另外 36 例患者在 35 天内需要进行永久性分流术。 关于分流并发症， 10 例（20%）患者出现头皮感染、 组织破裂和分流器暴露， 12 例（24%）患者出现 CSF 渗漏。 仅 2 例（4%）患者出现分流器移位。16 例（32%）需要进行分流器修正。4 例（8%）患者因败血症死亡。病死率的危险因素包括年龄较小、体重较低、男性、脑膜炎和/或脑室炎。
VSGS 是治疗感染后脑积水的一种安全有效的方法， 适用于等待永久性脑室-腹腔分流术的婴儿。 它证明 VSGS 缩短了住院时间和国家的经济负担。
