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腰大池-腹腔分流管的晚期鞘内回缩

Late intrathecal retraction of a lumboperitoneal shunt.

作者信息

Kim Young Ju, Fujita Atsushi, Maeyama Masahiro, Hori Tatsuo, Tanaka Kazuhiro, Sasayama Takashi

机构信息

Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.

出版信息

Surg Neurol Int. 2023 Dec 8;14:417. doi: 10.25259/SNI_742_2023. eCollection 2023.

DOI:10.25259/SNI_742_2023
PMID:38213441
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10783681/
Abstract

BACKGROUND

Lumboperitoneal (LP) shunt placement is a good option for treating elderly patients with communicating normal pressure hydrocephalus (NPH) who are also on antiplatelet therapy following endovascular treatment of unruptured bilateral internal carotid artery aneurysms. Here, in an 80-year-old male with an LP shunt, the catheter was "pinched" between adjacent spinous processes, resulting in laceration of the catheter and intrathecal catheter migration.

CASE DESCRIPTION

An 80-year-old male was treated with a LP shunt for NPH 1 year after undergoing endovascular treatment of unruptured bilateral internal carotid artery aneurysms. The lumbar catheter was placed at the L2-3 level. Six months later, when he clinically deteriorated, the follow-up computed tomography showed recurrent ventricular enlargement. Further, studies additionally confirmed intrathecal migration of the lumbar catheter, warranting secondary ventriculoperitoneal shunt placement.

CONCLUSION

Patients with LP shunts may develop lumbar catheter lacerations secondary to a "pinching" effect from adjacent spinous processes, resulting in intrathecal catheter migration.

摘要

背景

腰大池-腹腔（LP）分流术是治疗老年交通性正常压力脑积水（NPH）患者的一种良好选择，这些患者在未破裂双侧颈内动脉动脉瘤血管内治疗后还接受抗血小板治疗。在此，一名80岁男性患者置入了LP分流管，导管被相邻棘突“挤压”，导致导管撕裂和鞘内导管移位。

病例描述

一名80岁男性在未破裂双侧颈内动脉动脉瘤血管内治疗1年后因NPH接受LP分流术。腰段导管置于L2-3水平。6个月后，当他临床症状恶化时，随访计算机断层扫描显示脑室再次扩大。此外，研究进一步证实腰段导管发生鞘内移位，因此需要再次行脑室-腹腔分流术。

结论

LP分流术患者可能因相邻棘突的“挤压”效应导致腰段导管撕裂，从而引起鞘内导管移位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/7f7e8aeafefc/SNI-14-417-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/b10f769fc6c5/SNI-14-417-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/5c37a153bb93/SNI-14-417-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/18bf96c3ebc3/SNI-14-417-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/7f7e8aeafefc/SNI-14-417-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/b10f769fc6c5/SNI-14-417-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/5c37a153bb93/SNI-14-417-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/18bf96c3ebc3/SNI-14-417-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5bd/10783681/7f7e8aeafefc/SNI-14-417-g004.jpg

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Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy.荧光透视引导下经旁正中入路在脑脊液分流术中的应用：安全性和准确性评估。
Oper Neurosurg (Hagerstown). 2019 Apr 1;16(4):471-477. doi: 10.1093/ons/opy176.
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Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis.
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J Neurosurg. 2018 Oct;129(4):916-921. doi: 10.3171/2017.5.JNS17642. Epub 2017 Nov 10.
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