Brunberg J A, Kewitz G, Schumacher R E
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0030.
AJNR Am J Neuroradiol. 1993 May-Jun;14(3):595-603.
To describe brain CT alterations occurring after neonatal venovenous extracorporeal membrane oxygenation (V-V ECMO).
CT studies were prospectively obtained after V-V ECMO in 31 neonates with severe respiratory failure. Images were scored for cerebrospinal fluid space size, hemorrhage, and regions of decreased attenuation.
Subarachnoid space enlargement at the interhemispheric fissure, frontal, temporal, or parietal convexity occurred in 21 of the 31 patients. When subarachnoid space enlargement was asymmetric (six of the 21), it was always isolated to or greater on the right. Ventricular enlargement was demonstrated in seven of the 31. Hemorrhage occurred in seven and regions of low brain attenuation in 11 of the 31 neonates.
Increased sagittal sinus pressure caused by internal jugular vein ligation and cannulation of the superior vena cava may contribute to subarachnoid space enlargement by decreasing cerebrospinal fluid resorption at the arachnoid villi. Reduced incidence of cerebral hemorrhage with V-V ECMO, as compared with venoarterial (V-A) ECMO, may relate to sparing of the right common carotid artery (it is ligated with V-A ECMO), and to routing of oxygenated blood to the right atrium with V-V ECMO rather than to the arterial circuit as with V-A ECMO.
描述新生儿静脉-静脉体外膜肺氧合（V-V ECMO）后发生的脑CT改变。
前瞻性地获取了31例严重呼吸衰竭新生儿在V-V ECMO后的CT研究结果。对图像进行脑脊液间隙大小、出血情况以及低密度区域评分。
31例患者中有21例在大脑半球间裂、额叶、颞叶或顶叶凸面出现蛛网膜下腔增宽。当蛛网膜下腔增宽不对称时（21例中的6例），总是局限于右侧或右侧更明显。31例中有7例出现脑室扩大。31例新生儿中有7例发生出血，11例出现脑低密度区域。
颈内静脉结扎和上腔静脉插管导致的矢状窦压力升高，可能通过减少蛛网膜绒毛对脑脊液的吸收，导致蛛网膜下腔增宽。与静脉-动脉（V-A）ECMO相比，V-V ECMO脑出血发生率降低，可能与保留右侧颈总动脉（V-A ECMO时该动脉被结扎）以及V-V ECMO将氧合血输送至右心房而非像V-A ECMO那样输送至动脉循环有关。
