Rupprecht T, Lauffer K, Storr U, Hofbeck M, Wenzel D, Böwing B
Klinik mit Poliklinik für Kinder und Jugendliche der Universität Erlangen.
Klin Padiatr. 1996 May-Jun;208(3):97-102. doi: 10.1055/s-2008-1044003.
Extracerebral fluid collections in infancy are a common diagnostic problem, because by noninvasive imaging studies (including cranial ultrasonography, CT and NMR), no definite differentiation between two distinct pathological conditions can be found until today: An enlargement of the subarachnoid spaces in children with macrocephaly is a frequent observation of mostly unknown etiology but is known to be associated with a good prognosis. If surgery is necessary in these patients, ventricular shunting is required. On the other hand subdural effusions are often of traumatic origin and require frequently neurosurgical intervention (subdural shunting). Most reports on extracerebral fluid collections in infancy have not differentiated between both pathological conditions and therefore reveal confusing results. Recent studies using magnetic resonance imaging have shown that vascular flow phenomena in the arachnoid space can be used to a reliable diagnosis, whereas previous noninvasive neuroimaging attempts including high resolution computerized tomography (CT) have been useless.
We investigated a cohort of 20 patients aged 4 mths to 30 mths (mean 10.5 +/- 6.6 months) 16 with the history of macrocephaly and normal neurological development and 4 patients after head trauma and symptoms of an elevated intracranial pressure.
In all 16 patients with the clinical diagnosis of benign subarachnoid space enlargement colour coded Doppler sonography detected archnoid vessels within the fluid collection, furthermore high resolution ultrasound demonstrated the dural border of of the arachnoidea as an echogenic membrane, an observation useful as a further sign of the subarachnoid location of the fluid collection. In the 4 patients with subdural hematoma the fluid collection showed an increased echogenity, no vascular structures and no surrounding border.
Out of these observations we conclude that high resolution ultrasound and colour-Doppler sonography are able to reliably differentiate between a subdural and a subarachnoid fluid collection. An NMR investigation with its higher risks (sedation, anesthesia) focused on this target only seems therefore to be not necessary in these patients.
婴儿期脑外积液是一个常见的诊断难题，因为通过无创成像研究（包括头颅超声、CT和核磁共振），至今仍无法明确区分两种不同的病理状况：巨头畸形儿童蛛网膜下腔增宽是常见表现，其病因大多不明，但已知预后良好。若这些患者需要手术，则需进行脑室分流。另一方面，硬膜下积液通常由外伤引起，常需神经外科干预（硬膜下分流）。大多数关于婴儿期脑外积液的报告未区分这两种病理状况，因此结果令人困惑。最近使用磁共振成像的研究表明，蛛网膜下腔内的血管流动现象可用于可靠诊断，而此前包括高分辨率计算机断层扫描（CT）在内的无创神经成像尝试均无用处。
我们调查了一组年龄在4个月至30个月（平均10.5±6.6个月）的20例患者，其中16例有巨头畸形病史且神经发育正常，4例有头部外伤史及颅内压升高症状。
在所有16例临床诊断为良性蛛网膜下腔增宽的患者中，彩色编码多普勒超声在积液内检测到蛛网膜血管，此外高分辨率超声显示蛛网膜的硬膜边界为高回声膜，这一观察结果可作为积液位于蛛网膜下腔的进一步征象。在4例硬膜下血肿患者中，积液回声增强，无血管结构且无周边边界。
基于这些观察结果，我们得出结论，高分辨率超声和彩色多普勒超声能够可靠地区分硬膜下积液和蛛网膜下腔积液。因此，对于这些患者，仅针对这一目标进行风险较高（镇静、麻醉）的核磁共振检查似乎没有必要。
