小儿外部性脑积水诊疗进展_West China Medical Journal

Authors：

梁锐超 ,  贺民

Corresponding author：

贺民, Email: lrczb@163.com

Keywords：

小儿外部性脑积水; 病因; 诊断; 治疗

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外部性脑积水（EH）多发生于小儿，且是一种年龄依赖、随时间自限的病理状态，其病因及发病机制至今尚未阐明。EH分为特发性和继发性两大类，临床表现多为婴幼儿期间头颅迅速增大，头围大小与年龄不相称，其诊断为进一步认识此病，现对近年来国内外诊断、鉴别诊断、治疗与预后治疗小儿EH的相关文献资料进行回顾，总结其病因、诊断以及治疗上的进展。

Citation： 梁锐超,贺民. 小儿外部性脑积水诊疗进展. West China Medical Journal, 2012, 27(7): 1115-1118. doi: Copy

1.	Dandy WE, Blackfan KD. Internal hydrocephalus: an experimental clinical and pathological study[J]. Am J Dis Child, 1914, 8: 406-482.
2.	Robertson WC, Gomez MR. External hydrocephalus: early findings in congenital communicating hydrocephalus[J]. Arch Neurol, 1978, 35(8): 541-544.
3.	Sahar A. Pseudohydrocephalus-megalocephaly, increased intracranial pressure and widened subarachnoid space[J]. Neuropadiatrie, 1978, 9(2): 131-139.
4.	Alvarez LA, Maytal J, Shinnar S. Idiopathic external hydrocephalus: natural history and relationship to benign familial macrocephaly[J]. Pediatrics, 1986, 77(6): 901-907.
5.	Andersson H, Elfverson J, Svendsen P. External hydrocephalus in infants[J]. Childs Brain, 1984, 11(6): 398-402.
6.	Papasian NC, Frim DM. A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma[J]. Pediatr Neurosurg, 2000, 33(4): 188-193.
7.	Robertson WC Jr, Chun RW, Orrison WW, et al. Benign subdural collections of infancy[J]. J Pediatr, 1979, 94(3): 382-386.
8.	Pettit RE, Kilroy AW, Allen JH. Macrocephaly with head growth parallel to normal growth pattern: neurological, developmental, and computerized tomography findings in full-term infants[J]. Arch Neurol, 1980, 37(8): 518-521.
9.	Castro-Gago M, Pérez-Gómez C, Novo-Rodríguez MI, et al. Benign idiopathic external hydrocephalus (benign subdural collection) in 39 children: its natural history and relation to familial macrocephaly[J]. Rev Neurol, 2005, 40(9): 513-517.
10.	Akaboshi I, Ikeda T, Yoshioka S. Benign external hydrocephalus in a boy with autosomal dominant microcephaly[J]. Clin Genet, 1996, 49(3): 160-162.
11.	Piatt JH Jr. Monozygotic twins discordant for external hydrocephalus[J]. Pediatr Neurosurg, 2001, 35(4): 211-215.
12.	Erdinçler P, Dashti R, Kaynar MY, et al. Hydrocephalus and chronically increased intracranial pressure in achondroplasia[J]. Childs Nerv Syst, 1997, 13(6): 345-348.
13.	Paciorkowski AR, Greenstein RM. When is enlargement of the subarachnoid spaces not benign? A genetic perspective[J]. Pediatr Neurol, 2007, 37(1): 1-7.
14.	Lim JJ, Yoon SH. The first neurosurgical analysis of 8 korean children with sotos syndrome[J]. J Korean Neurosurg Soc, 2008, 44(4): 240-244.
15.	Al-Saedi SA, Lemke RP, Debooy VD, et al. Subarachnoid fluid collections: a cause of macrocrania in preterm infants[J]. J Pediatr, 1996, 128(2): 234-236.
16.	Hellbusch LC. Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up[J]. J Neurosurg, 2007, 107(2 Suppl): 119-125.
17.	Rekate HL. Hydrocephalus in children[M]//Winn HR, Youmans JR. Youmans neurological Surgery. 5th ed. St. Louis: Saunders, 2003: 3387-3404.
18.	Bateman GA, Napier BD. External hydrocephalus in infants: six cases with Mr venogram and flow quantification correlation[J]. Childs Nerv Syst, 2011, 27(12): 2087-2096.
19.	Bhasker B, Raghupathy P, Nair TM, et al. External hydrocephalus in primary hypomagnesaemia: a new finding[J]. Arch Dis Child, 1999, 81(6): 505-507.
20.	Edwards RJ, Allport TD, Stoodley NG, et al. External hydrocephalus and subdural bleeding in infancy associated with transplacental anti-Ro antibodies[J]. Arch Dis Child, 2012, 97(4): 316-319.
21.	Arbour L, Watters GV, Hall JG, et al. Multifactorial inheritance of non-syndromic macrocephaly[J]. Clin Genet, 1996, 50(2): 57-62.
22.	Rekate HL. A contemporary definition and classification of hydrocephalus[J]. Semin Pediatr Neurol, 2009, 16(1): 9-15.
23.	Barlow CF. CSF dynamics in hydrocephalus--with special attention to external hydrocephalus[J]. Brain Dev, 1984, 6(2): 119-127.
24.	Kendall B, Holland I. Benign communicating hydrocephalus in children[J]. Neuroradiology, 1981, 21(2): 93-96.
25.	Maytal J, Alvarez LA, Elkin CM, et al. External hydrocephalus: radiologic spectrum and differentiation from cerebral atrophy[J]. AJR Am J Roentgenol, 1987, 148(6): 1223-1230.
26.	Azais M, Echenne B. Idiopathic pericerebral swelling (external hydrocephalus) of infants[J]. Ann Pediatr (Paris), 1992, 39(9): 550-558.
27.	Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R. A study and follow-up of ten cases of benign enlargement of the subarachnoid spaces[J]. Rev Neurol, 2004, 39(8): 701-706.
28.	Laubscher B, Deonna T, Uske A, et al. Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus[J]. Eur J Pediatr, 1990, 149(7): 502-507.
29.	Kumar R. External hydrocephalus in small children[J]. Childs Nerv Syst, 2006, 22(10): 1237-1241.
30.	Lam WW, Ai VH, Wong V, et al. Ultrasonographic measurement of subarachnoid space in normal infants and children[J]. Pediatr Neurol, 2001, 25(5): 380-384.
31.	Prassopoulos P, Cavouras D. CT evaluation of normal CSF spaces in children: Relationship to age, gender and cranial size[J]. Eur J Radiol, 1994, 18(1): 22-25.
32.	Narli N, Soyupak S, Yildizdaş HY, et al. Ultrasonographic measurement of subarachnoid space in normal term newborns[J]. Eur J Radiol, 2006, 58(1): 110-112.
33.	Sun M, Yuan W, Hertzler DA, et al. Diffusion tensor imaging findings in young children with benign external hydrocephalus differ from the normal population[J]. Childs Nerv Syst, 2012, 28(2): 199-208.
34.	袁海斌. 婴幼儿外部性脑积水诊断与分度方法的探讨[J]. 中华实用中西医杂志, 2004, 4(17): 3782-3784.
35.	彭赞新. 婴幼儿外部性脑积水的CT诊断与鉴别诊断[J]. 中国医疗前沿, 2009, 04(16): 76-76,102.
36.	段建航, 席德彦, 朱坤. 婴儿良性外部性脑积水的16层螺旋CT诊断[J]. 中国实用神经疾病杂志, 2011, 14(5): 92-93.
37.	Shen WC, Yang CF, Chang T. Benign hydrocephalus in infants. A computed tomographic and clinical correlative study[J]. Acta Radiol Suppl, 1986, 369: 689-691.
38.	Nishimura K, Mori K, Sakamoto T, et al. Management of subarachnoid fluid collection in infants based on a long-term follow-up study[J]. Acta Neurochir, 1996, 138(2): 179-184.
39.	徐宁. 外部性脑积水对婴幼儿认知发育的影响[J]. 中国妇幼保健, 2006, 21(13): 1813-1814.
40.	史长松, 高丽. 综合干预治疗外部性脑积水30例报告[J]. 陕西医学杂志, 2003, 32(4): 308-310.
41.	Muenchberger H, Assaad N, Joy P, et al. Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome[J]. Childs Nerv Syst, 2006, 22(10): 1242-1248.
42.	Ravid S, Maytal J. External hydrocephalus: a probable cause for subdural hematoma in infancy[J]. Pediatr Neurol, 2003, 28(2): 139-141.

1. 　Dandy WE, Blackfan KD. Internal hydrocephalus: an experimental clinical and pathological study[J]. Am J Dis Child, 1914, 8: 406-482.
2. 　Robertson WC, Gomez MR. External hydrocephalus: early findings in congenital communicating hydrocephalus[J]. Arch Neurol, 1978, 35(8): 541-544.
3. 　Sahar A. Pseudohydrocephalus-megalocephaly, increased intracranial pressure and widened subarachnoid space[J]. Neuropadiatrie, 1978, 9(2): 131-139.
4. 　Alvarez LA, Maytal J, Shinnar S. Idiopathic external hydrocephalus: natural history and relationship to benign familial macrocephaly[J]. Pediatrics, 1986, 77(6): 901-907.
5. 　Andersson H, Elfverson J, Svendsen P. External hydrocephalus in infants[J]. Childs Brain, 1984, 11(6): 398-402.
6. 　Papasian NC, Frim DM. A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma[J]. Pediatr Neurosurg, 2000, 33(4): 188-193.
7. 　Robertson WC Jr, Chun RW, Orrison WW, et al. Benign subdural collections of infancy[J]. J Pediatr, 1979, 94(3): 382-386.
8. 　Pettit RE, Kilroy AW, Allen JH. Macrocephaly with head growth parallel to normal growth pattern: neurological, developmental, and computerized tomography findings in full-term infants[J]. Arch Neurol, 1980, 37(8): 518-521.
9. 　Castro-Gago M, Pérez-Gómez C, Novo-Rodríguez MI, et al. Benign idiopathic external hydrocephalus (benign subdural collection) in 39 children: its natural history and relation to familial macrocephaly[J]. Rev Neurol, 2005, 40(9): 513-517.
10. 　Akaboshi I, Ikeda T, Yoshioka S. Benign external hydrocephalus in a boy with autosomal dominant microcephaly[J]. Clin Genet, 1996, 49(3): 160-162.
11. 　Piatt JH Jr. Monozygotic twins discordant for external hydrocephalus[J]. Pediatr Neurosurg, 2001, 35(4): 211-215.
12. 　Erdinçler P, Dashti R, Kaynar MY, et al. Hydrocephalus and chronically increased intracranial pressure in achondroplasia[J]. Childs Nerv Syst, 1997, 13(6): 345-348.
13. 　Paciorkowski AR, Greenstein RM. When is enlargement of the subarachnoid spaces not benign? A genetic perspective[J]. Pediatr Neurol, 2007, 37(1): 1-7.
14. 　Lim JJ, Yoon SH. The first neurosurgical analysis of 8 korean children with sotos syndrome[J]. J Korean Neurosurg Soc, 2008, 44(4): 240-244.
15. 　Al-Saedi SA, Lemke RP, Debooy VD, et al. Subarachnoid fluid collections: a cause of macrocrania in preterm infants[J]. J Pediatr, 1996, 128(2): 234-236.
16. 　Hellbusch LC. Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up[J]. J Neurosurg, 2007, 107(2 Suppl): 119-125.
17. 　Rekate HL. Hydrocephalus in children[M]//Winn HR, Youmans JR. Youmans neurological Surgery. 5th ed. St. Louis: Saunders, 2003: 3387-3404.
18. 　Bateman GA, Napier BD. External hydrocephalus in infants: six cases with Mr venogram and flow quantification correlation[J]. Childs Nerv Syst, 2011, 27(12): 2087-2096.
19. 　Bhasker B, Raghupathy P, Nair TM, et al. External hydrocephalus in primary hypomagnesaemia: a new finding[J]. Arch Dis Child, 1999, 81(6): 505-507.
20. 　Edwards RJ, Allport TD, Stoodley NG, et al. External hydrocephalus and subdural bleeding in infancy associated with transplacental anti-Ro antibodies[J]. Arch Dis Child, 2012, 97(4): 316-319.
21. 　Arbour L, Watters GV, Hall JG, et al. Multifactorial inheritance of non-syndromic macrocephaly[J]. Clin Genet, 1996, 50(2): 57-62.
22. 　Rekate HL. A contemporary definition and classification of hydrocephalus[J]. Semin Pediatr Neurol, 2009, 16(1): 9-15.
23. 　Barlow CF. CSF dynamics in hydrocephalus--with special attention to external hydrocephalus[J]. Brain Dev, 1984, 6(2): 119-127.
24. 　Kendall B, Holland I. Benign communicating hydrocephalus in children[J]. Neuroradiology, 1981, 21(2): 93-96.
25. 　Maytal J, Alvarez LA, Elkin CM, et al. External hydrocephalus: radiologic spectrum and differentiation from cerebral atrophy[J]. AJR Am J Roentgenol, 1987, 148(6): 1223-1230.
26. 　Azais M, Echenne B. Idiopathic pericerebral swelling (external hydrocephalus) of infants[J]. Ann Pediatr (Paris), 1992, 39(9): 550-558.
27. 　Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R. A study and follow-up of ten cases of benign enlargement of the subarachnoid spaces[J]. Rev Neurol, 2004, 39(8): 701-706.
28. 　Laubscher B, Deonna T, Uske A, et al. Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus[J]. Eur J Pediatr, 1990, 149(7): 502-507.
29. 　Kumar R. External hydrocephalus in small children[J]. Childs Nerv Syst, 2006, 22(10): 1237-1241.
30. 　Lam WW, Ai VH, Wong V, et al. Ultrasonographic measurement of subarachnoid space in normal infants and children[J]. Pediatr Neurol, 2001, 25(5): 380-384.
31. 　Prassopoulos P, Cavouras D. CT evaluation of normal CSF spaces in children: Relationship to age, gender and cranial size[J]. Eur J Radiol, 1994, 18(1): 22-25.
32. 　Narli N, Soyupak S, Yildizdaş HY, et al. Ultrasonographic measurement of subarachnoid space in normal term newborns[J]. Eur J Radiol, 2006, 58(1): 110-112.
33. 　Sun M, Yuan W, Hertzler DA, et al. Diffusion tensor imaging findings in young children with benign external hydrocephalus differ from the normal population[J]. Childs Nerv Syst, 2012, 28(2): 199-208.
34. 　袁海斌. 婴幼儿外部性脑积水诊断与分度方法的探讨[J]. 中华实用中西医杂志, 2004, 4(17): 3782-3784.
35. 　彭赞新. 婴幼儿外部性脑积水的CT诊断与鉴别诊断[J]. 中国医疗前沿, 2009, 04(16): 76-76,102.
36. 　段建航, 席德彦, 朱坤. 婴儿良性外部性脑积水的16层螺旋CT诊断[J]. 中国实用神经疾病杂志, 2011, 14(5): 92-93.
37. 　Shen WC, Yang CF, Chang T. Benign hydrocephalus in infants. A computed tomographic and clinical correlative study[J]. Acta Radiol Suppl, 1986, 369: 689-691.
38. 　Nishimura K, Mori K, Sakamoto T, et al. Management of subarachnoid fluid collection in infants based on a long-term follow-up study[J]. Acta Neurochir, 1996, 138(2): 179-184.
39. 　徐宁. 外部性脑积水对婴幼儿认知发育的影响[J]. 中国妇幼保健, 2006, 21(13): 1813-1814.
40. 　史长松, 高丽. 综合干预治疗外部性脑积水30例报告[J]. 陕西医学杂志, 2003, 32(4): 308-310.
41. 　Muenchberger H, Assaad N, Joy P, et al. Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome[J]. Childs Nerv Syst, 2006, 22(10): 1242-1248.
42. 　Ravid S, Maytal J. External hydrocephalus: a probable cause for subdural hematoma in infancy[J]. Pediatr Neurol, 2003, 28(2): 139-141.

West China Medical Journal

小儿外部性脑积水诊疗进展

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