儿童期后窝肿瘤并发脑积水的处理。

M S Dias, A L Albright
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引用次数: 65

摘要

我们研究了儿童后窝肿瘤脑积水的治疗方法,以:(1)比较脑室外引流(EVD)和脑室-腹膜分流(VPS)的使用,(2)确定术后脑积水需要永久性分流的频率,(3)确定哪些因素预测需要永久性分流。本文回顾性分析了1979年至1987年在我院治疗的58例小儿后窝肿瘤及相关脑积水病例。脑积水的初始治疗包括25例VPS, 17例EVD, 16例未治疗。“VPS”、“EVD”和“未治疗”组的患者仅在脑积水的严重程度(未治疗组的严重程度低于VPS和EVD组)和肿瘤切除术后硬脑膜闭合方法(EVD组和未治疗组的硬脑膜更常打开)方面存在差异。在33例最初未分流的患者中,只有9例(27%)随后需要分流。这些患者与其余24名不需要分流术的患者进行比较。两个特征预测了后续分流术的需要:(1)仅切除一小部分肿瘤;(2)肿瘤切除后硬脑膜开放。EVD并发症少;在室性导尿管移除期间或之后,无患者神经系统恶化。我们的结论是,三分之二到四分之三的儿童后窝肿瘤和相关脑积水患者可以通过围手术期EVD治疗,不需要分流。仅行小肿瘤切除和硬脑膜开放的患者更有可能需要永久性VPS。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of hydrocephalus complicating childhood posterior fossa tumors.

We examined the treatment of hydrocephalus in children with posterior fossa tumors to (1) compare the use of external ventricular drainage (EVD) with ventriculoperitoneal shunts (VPS), (2) determine the frequency of postoperative hydrocephalus requiring permanent shunts, and (3) determine which factors predict the need for a permanent shunt. The records of 58 children with posterior fossa tumors and associated hydrocephalus treated at our institution from 1979 to 1987 were retrospectively reviewed. Initial management of hydrocephalus included VPS in 25 patients, EVD in 17, and no treatment in 16. Patients in the 'VPS', 'EVD', and 'no treatment' groups differed only in the severity of hydrocephalus (less severe in the no treatment group than in the VPS and EVD groups) and in the method of dural closure following tumor resection (dura was left open more often in the EVD and no treatment groups). Of the 33 patients not initially shunted, only 9 (27%) subsequently required a shunt. These patients were compared with the remaining 24 patients who did not require a shunt. Two features predicted the need for a subsequent shunt: (1) resection of only a small volume of tumor and (2) the dura open following tumor resection. Complications of EVD were few; no patient deteriorated neurologically during or after ventricular catheter removal. We conclude that between two thirds and three quarters of patients with childhood posterior fossa tumors and associated hydrocephalus may be managed with perioperative EVD and will not require shunts. Patients in whom only a minimal tumor resection is performed and those in whom the dura is left open are more likely to need permanent VPS.

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