特发性室外脑脊液通路阻塞所致脑积水的神经放射学特征

K. V. Shevchenko, V. Shimanskiy, S. V. Tanyashin, V. K. Poshataev, V. V. Karnaukhov, Y. Strunina, K. Solozhentseva, I. N. Pronin, L. R. Gabrielyan, I. O. Kugushev
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引用次数: 0

摘要

随着脑脊液流动障碍研究的发展,最初将脑积水分为 "交流性 "和 "非交流性",后来又区分出 "脑室内 "和 "脑室外 "梗阻的概念。放射成像技术的改进使我们能够确定脑脊液阻塞的确切程度。在某些情况下,脑脊液流动障碍会合并不同形式的脑积水症状。正确的分类有助于选择手术治疗的类型,从而降低并发症的发生率和患者对医生的依赖性。研究目的研究特发性后颅窝蝶窦阻塞性脑积水的影像学表现。材料和方法。这项研究包括特发性疾病的成年患者(18 岁及以上)。从 2007 年到 2020 年,289 名被诊断为特发性脑积水的患者在 N. N. Burdenko 国立神经外科医学研究中心接受了治疗。其中,65 名患者(18.7%)有室外梗阻的临床和影像学症状。男女比例分别为 25 和 40(38.5 % 和 61.5 %)。对各种放射学征象进行了评估,并确定了它们在各种特发性脑积水中的起源和发生率。结果显示FOHR最高(与其他形式的特发性脑积水(平均值为0.52)相比)。其他脑室指数也很高。这些指数都与患者的病情无关。89.2%的患者发现颞前膜腹侧脱位。51例(78.4%)患者的土耳其鞍大小正常,13例(20%)患者的土耳其鞍增大。18.4%的患者脑室周围信号发生变化。所有病例的导水管和第四脑室出口都是通畅的,这在 T2 3D CUBE 的 CSF 搏动伪影中得到了证明。63 例(96.9%)患者的大脑导水管扩张。90.7%的患者的小脑尾部萎缩伴有大小脑幕扩大,这一征象对室外顺行性阻塞有显著意义(P <0.001)。除 T2 模式外,蝶窦造影模式(FIESTA 或 CISS)的矢状切面也是先决条件。通过这些模式,可以更清楚地观察到前绒毛膜的腹侧脱位,排除脑导水管中存在的 CSF 流动障碍,最重要的是,可以确定在脑干腹侧表面和颅窦之间的蛛网膜下腔中是否存在额外的膜。100%的患者都发现了这些附加膜,这也是一个重要的致病征兆(p < 0.001)。结论脑积水伴后颅窝蝶窦水平梗阻的磁共振成像图像具有特殊征象。它结合了其他形式脑积水的体征、慢性疾病以及 CSF 通路阻塞的症状。可将其归类为一种独立的形式,内窥镜手术和分流手术均可用于治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neuroradiological characteristics of hydrocephalus due to idiopathic extraventricular CSF pathways obstruction
The development of research on CSF flow disorders made it possible initially to divide hydrocephalus into «communicating» and «non-communicating», and subsequently to distinguish the concepts of «intraventricular» and «extraventricular» obstruction. Improvement of radiological imaging technologies has allowed determining the exact level of CSF obstruction. In some cases, CSF flow disorders combine signs of different forms of hydrocephalus. Their correct classification allows selecting the type of surgical treatment, which reduces the rate of complications and patient»s dependence on the doctor. Purpose of the research: To study the radiological signs of hydrocephalus in idiopathic obstruction at the level of the posterior cranial fossa cisterns. Materials and methods. This study included adult patients (18 years old and over) whose disease was idiopathic in nature. From 2007 to 2020, 289 patients diagnosed with idiopathic hydrocephalus were treated at the N. N. Burdenko National Medical Research Center of Neurosurgery. Of these, 65 patients (18.7 %) had clinical and radiological signs of extraventricular obstruction. The male to female ratio was 25 and 40 (38.5 % and 61.5 %), respectively. A variety of radiological signs were assessed and their origin and occurrence in various forms of idiopathic hydrocephalus were determined. Results. FOHR was the highest (compared with other forms of idiopathic hydrocephalus (mean 0.52)). Other ventricular indices were also high. None of them correlated with the patient»s condition. Ventral dislocation of the premamillary membrane was detected in 89.2 %. Turkish saddle was of normal size in 51 (78.4 %) patients, while its enlargement was found in 13 (20 %) patients. A change in the periventricular signal was noted in 18.4 %. Aqueduct and IV ventricle outlets were patent in all cases as evidenced by CSF pulsation artifacts in T2 3D CUBE. The cerebral aqueduct was dilated in 63 (96.9 %) patients. Enlargement of the cisterna magna associated with hypotrophy of the caudal cerebellum was noted in 90.7 %, and this sign was significant for extraventricular cisternal obstruction (p <0.001). In addition to the T2 mode, the presence of sagittal sections in cisternography modes (FIESTA or CISS) was a prerequisite. By means of these modes, the ventral dislocation of the premamillary membrane was more clearly visualized, the presence of obstacles to the CSF flow in the cerebral aqueduct was excluded, and, most importantly, it was possible to determine the presence of additional membranes in the subarachnoid spaces between the ventral surface of the brain stem and the clivus. These were found in 100 % of the patients, which was also a significant pathognomonic sign (p < 0.001). Conclusion. The MRI picture of hydrocephalus with obstruction at the level of the posterior cranial fossa cisterns has specific signs. It combines the signs of other forms of hydrocephalus, chronic disease in combination with symptoms of the CSF pathways obstruction. It can be classified into a separate form and both endoscopic and shunt surgery can be used for treatment.
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