Fouyas I P, Casey A T, Thompson D, Harkness W F, Hayward R D
Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children, London, England.
Neurosurgery. 1996 Apr;38(4):726-31; discussion 731-2.
Although the clinical and radiological diagnosis of hydrocephalus in children is usually straightforward, there exists a minority of patients in whom the decision to shunt can be extremely difficult. Similarly, although the diagnosis of shunt malfunction usually presents little difficulty in the context of an acute blockage, a child can present with a confusing and unpredictable constellation of symptoms that might be caused by conditions separate from shunt malfunction. Continuous intraparenchymal intracranial pressure (ICP) monitoring was used to assess 41 patients with hydrocephalus, either as part of the initial diagnostic evaluation of ventriculomegaly (18 patients) or in the assessment of presumed shunt malfunction (23 patients). In 9 of 18 patients with ventriculomegaly, the ICP was within normal limits and surgical insertion of shunts was avoided. Of the 23 patients being assessed for shunt malfunction, the change in ICP profile indicated a siphoning or overdrainage process in 13. In no patient was there significant attendant morbidity, and the process was well tolerated and simple to perform. Clinical and radiological criteria alone can afford insufficient information in the initial evaluation and the subsequent management of the child with hydrocephalus. ICP monitoring provides a safe means of investigating such patients and provides valuable information upon which to base surgical management.
尽管儿童脑积水的临床和影像学诊断通常很直接，但仍有少数患者的分流决策可能极其困难。同样，虽然在急性阻塞的情况下，分流故障的诊断通常没有什么困难，但儿童可能会出现一系列令人困惑且不可预测的症状，这些症状可能由与分流故障无关的疾病引起。连续脑实质内颅内压（ICP）监测用于评估41例脑积水患者，其中一部分是作为脑室扩大初始诊断评估的一部分（18例患者），另一部分是在评估疑似分流故障时（23例患者）。在18例脑室扩大患者中，有9例ICP在正常范围内，避免了分流手术的植入。在评估分流故障的23例患者中，ICP曲线的变化表明13例存在虹吸或引流过度的情况。没有患者出现明显的伴随发病率，该过程耐受性良好且操作简单。仅依靠临床和影像学标准，在脑积水患儿的初始评估和后续管理中可能提供的信息不足。ICP监测为研究此类患者提供了一种安全的方法，并为手术管理提供了有价值的信息。
