Sakamoto H, Kitano S, Nishikawa M, Fujitani K
Department of Pediatric Neurosurgery, Osaka City General Hospital, Japan.
Acta Neurochir Suppl. 1998;71:357-9. doi: 10.1007/978-3-7091-6475-4_103.
For maintaining the intracranial buffering capacity against shunt obstruction, we tried to seek the most suitable size of the lateral ventricles in hydrocephalic children. Thirty-seven shunted-hydrocephalic children who required emergent revision of the shunt were analyzed. At the time of shunt obstruction, the lateral ventricle remained small (0.35 or less than 0.35 on the Evans' index) in 13 patients (Slit-like group), but it enlarged (more than 0.35 on the Evans' index) in 24 patients (Dilated group). The mean age in the Slit-like group was significantly older than in the Dilated group and there was no patient younger than 3 years in the Slit-like group. Compared with the Dilated group, the Slit-like group showed significantly rapid deterioration into lethargy after shunt obstruction. Also, at the time of obstruction CT scans showed a significantly higher rate of narrowing of the ambient cistern. While the shunt was working well before shunt obstruction, the Evans' index was less than 0.33 in all patients of the Slit-like group. In conclusion, because small ventricles after shunt strongly suggest the presence of ventricular tautness, the lateral ventricular size should be maintained at more than 0.33 on the Evans' index in shunted children at an age of 3 or more than 3 years.
为维持颅内对分流梗阻的缓冲能力，我们试图探寻脑积水患儿侧脑室的最合适大小。对37例需要紧急修订分流术的分流性脑积水患儿进行了分析。在分流梗阻时，13例患儿（裂隙样组）的侧脑室仍较小（埃文斯指数为0.35或小于0.35），但24例患儿（扩张组）的侧脑室增大（埃文斯指数大于0.35）。裂隙样组的平均年龄显著大于扩张组，且裂隙样组中没有年龄小于3岁的患儿。与扩张组相比，裂隙样组在分流梗阻后出现嗜睡的病情恶化速度明显更快。此外，在梗阻时的CT扫描显示，环池变窄的发生率显著更高。在分流梗阻前分流功能良好时，裂隙样组所有患儿的埃文斯指数均小于0.33。总之，由于分流后侧脑室较小强烈提示存在脑室紧绷，对于3岁及3岁以上的分流患儿，应将侧脑室大小维持在埃文斯指数大于0.33。
