Yamasaki S, Tanaka M, Hirayama A, Osaka K, Matsumoto S
No Shinkei Geka. 1977 Mar;5(3):235-42.
Out of 122 hydrocephalic infants and children treated by cerebrospinal fluid shunt, post-shunt subdural hematoma was found in 11 patients in total, 8 cases with non-tumorous hydrocephalus and 3 cases with brain tumors obstructing the cerebrospinal fluid pathway. In most cases the diagnosis of subdural hematoma was delayed since signs of increased intracranial pressure were absent initially. The signs of increased intracranial pressure appeared later, when the shunted venricle collapsed and could not give any more space to the growing subdural hematoma. At this stage those cases were easily misdiagnosed as shunt dysfunction. Post-shunt subdural hematoma was apparently induced by the tear of the bridging vein or leakage of the cerebrospinal fluid into the subdural space through the torn arachnoid membrane due to over-drainage of the cerebrospinal fluid, especially when the patients took the erect position. Since such a complication is not rare and difficult to be diagnosed, intensive follow-up is necessary in the post-shunt period. The precautionary measures as well as the treatment for these subdural hematoma were also discussed.
在122例接受脑脊液分流治疗的脑积水婴幼儿中，共有11例发生了分流术后硬膜下血肿，其中8例为非肿瘤性脑积水，3例为阻塞脑脊液通路的脑肿瘤。在大多数情况下，硬膜下血肿的诊断被延迟，因为最初没有颅内压升高的迹象。当分流的脑室塌陷，无法再为不断增大的硬膜下血肿提供空间时，颅内压升高的迹象才会出现。在这个阶段，这些病例很容易被误诊为分流功能障碍。分流术后硬膜下血肿显然是由于桥静脉撕裂或脑脊液过度引流导致脑脊液通过撕裂的蛛网膜下腔漏入硬膜下间隙引起的，尤其是当患者采取直立位时。由于这种并发症并不罕见且难以诊断，因此在分流术后需要进行密切随访。文中还讨论了这些硬膜下血肿的预防措施和治疗方法。
