Leviton A, Gilles F
Neurology Department, Children's Hospital, Boston, MA 02115, USA.
Pediatr Neurol. 1996 Sep;15(2):127-36. doi: 10.1016/0887-8994(96)00157-9.
Preterm infants, including some who have sustained intracranial hemorrhage, appear to be at increased risk of lateral ventricular enlargement. Although some occurrences might be due to an impairment of cerebrospinal fluid flow or absorption, many instances of ventriculomegaly without accompanying macrocephaly reflect diffuse white matter damage resulting in diminished (i.e., hypoplastic) white matter or an inadequate density of axons. Perinatally acquired widespread white matter damage is sometimes associated with the focal white matter necrosis. We hypothesize that in some infants both ventriculomegaly and delayed myelination are consequences of disturbances to myelinogenesis that result from an impairment of cells destined to become oligodendroglia or of disturbances to rapidly growing axons. The vulnerability of developing white matter in preterm newborns might, in part, reflect the diminished availability of growth/ survival factors, or a vulnerability to toxins or physiologic perturbations. Awareness that some ventriculomegaly reflects widely distributed white matter damage should prevent overtreatment of what might appear to be hydrocephalus, but is not due to impaired cerebrospinal fluid dynamics. Increased understanding of the phenomena leading to ventriculomegaly related to paucity of white matter should lead to successful efforts to prevent white matter damage in preterm newborns.
早产儿，包括一些发生过颅内出血的婴儿，似乎发生侧脑室扩大的风险增加。虽然有些情况可能是由于脑脊液流动或吸收受损所致，但许多无巨头症伴随的脑室扩大病例反映了弥漫性白质损伤，导致白质减少（即发育不全）或轴突密度不足。围生期获得性广泛白质损伤有时与局灶性白质坏死有关。我们推测，在一些婴儿中，脑室扩大和髓鞘形成延迟都是由注定要成为少突胶质细胞的细胞受损或快速生长的轴突受到干扰而导致的髓鞘形成障碍所引起的。早产新生儿发育中的白质的易损性，部分可能反映了生长/存活因子的可利用性降低，或对毒素或生理扰动的易感性。认识到一些脑室扩大反映了广泛分布的白质损伤，应避免对看似脑积水但并非由脑脊液动力学受损引起的情况进行过度治疗。对导致与白质缺乏相关的脑室扩大现象的进一步了解，应有助于成功地预防早产新生儿的白质损伤。
