Morota N, Sakamoto K, Kobayashi N, Kitazawa K, Kobayashi S
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Childs Nerv Syst. 1995 Aug;11(8):459-66. doi: 10.1007/BF00334966.
The authors reviewed 47 cases of infantile subdural fluid collection with regard to diagnosis and postoperative course after placement of a subdural-peritoneal shunt. CT scan with contrast enhancement proved to be an important diagnostic modality, showing vessels in the subarachnoid space as high-density spots. Utilizing this technique, we were able to differentiate the following varieties of fluid collection: (1) subdural fluid collection, in which enhancing vessels were seen on the brain surface, (2) subarachnoid fluid collection, in which vessels were on the inner table of the cranium, and (3) coexistence of subdural and subarachnoid fluid collections, in which vessels were between the inner table of the cranium and the brain surface. The postoperative course of subdural fluid collection was characterized as follows: (1) the subdural fluid collection decreased first, with increased subarachnoid fluid collection; (2) the subarachnoid fluid collection remained after the disappearance of subdural fluid collection; and (3) the brain expanded again later. Subdural fluid collection disappeared about 1 month after the shunt operation, which could lead occlusion of the shunt system. Postoperative enlargement of the subarachnoid space was an early indicator of the efficacy of the subdural-peritoneal shunt.
作者回顾了47例婴儿硬膜下积液病例，探讨了硬膜下-腹腔分流术后的诊断及术后病程。增强CT扫描被证明是一种重要的诊断方法，可显示蛛网膜下腔内的血管为高密度斑点。利用该技术，我们能够区分以下几种积液类型：（1）硬膜下积液，脑表面可见强化血管；（2）蛛网膜下腔积液，血管位于颅骨内板；（3）硬膜下和蛛网膜下腔积液并存，血管位于颅骨内板与脑表面之间。硬膜下积液的术后病程特点如下：（1）硬膜下积液先减少，蛛网膜下腔积液增多；（2）硬膜下积液消失后蛛网膜下腔积液仍存在；（3）随后脑再次扩张。硬膜下积液在分流术后约1个月消失，这可能导致分流系统堵塞。蛛网膜下腔术后扩大是硬膜下-腹腔分流术疗效的早期指标。
