Objective To systematically review the clinical effectiveness and safety of programmable valves (PV) vs. standard valves (SV) for hydrocephalus. Methods Literature search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and WanFang Data to collect both randomized controlled trials (RCTs) and non-randomized concurrent controlled trials on hydrocephalus treated by PV and SV published from January 1992 to January 2012. According to the inclusion criteria, two reviewers independently screened articles, extracted data, and evaluated and cross-checked the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 11 non-randomized concurrent controlled trials involving 1,485 participants were included. The results of meta-analysis showed that, compared with SV, PV was superior in overall effective rate (RR=1.14, 95%CI 1.03 to 1.27, P=0.01), 2-year survival rate (RR=1.25, 95%CI 1.04 to 1.51, P=0.02), secondary surgery rate (RR=0.53, 95%CI 0.39 to 0.73, Plt;0.001), overall complications rate (RR=0.62, 95%CI 0.51 to 0.76, Plt;0.001), and over-drainage/ under-drainage rates (RR=0.42, 95%CI 0.21 to 0.83, P=0.01). But there were no significant differences in 1-year survival rate (RR=1.04, 95%CI 0.91 to 1.19, P=0.55), postoperative infection rate (RR=1.08, 95%CI 0.73 to 1.60, P=0.71) and valve related complication rate (RR=0.80, 95%CI 0.56 to 1.21, P=0.20) between the two groups. Conclusion Current evidence suggests that PV is superior to SV in increasing the effective rate, decreasing complications, and prolonging the long-term survival rate. Because of the limitation of quantity and quality of the included studies, more high quality, multicenter and double-blind RCTs are needed to prove whether PV can be clinically recommended as a preferred drainage surgery or not.
Objective To evaluate the clinical effectiveness of endoscopic third ventriculostomy (ETV) and ventriculal peritoneum shunt (VPS) for hydrocephalus. Methods A fully recursive literature search was conducted in PubMed (1996 to June, 2011), EMBASE (1996 to June, 2011), Cochrane Central Register of Controlled Trials (Issue 3, 2011), CBM (1996 to June, 2011), CNKI and Wanfang Database (1996 to June, 2011) in any language. The randomized or non-randomized controlled trials of hydrocephalus treated by endoscopic third ventriculostomy and ventriculal peritoneum shunt were considered for inclusion. The analyzed outcome variables were overall complications and the survival rate of all time points. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out by using RevMan 5.0 software. Results Nine published reports of eligible studies involving 1 187 participants met the inclusion criteria. Compared with VPS, ETV had no significant differences in short-term (1 or 2 years) survival rate (RR=1.02, 95%CI 0.90 to 1.16, P=0.74; RR=1.14, 95%CI 1.00 to 1.30, P=0.06), but there were significant differences between the two groups in overall complication rate (RR=0.70, 95%CI 0.57 to 0.89, P=0.001), postoperative 3-year survival rate (RR=1.23, 95%CI 1.07 to 1.41, P=0.004), and postoperative 5-year survival rate (RR=1.14, 95%CI 1.29 to 1.66, P=0.05). So the outcomes indicated ETV was superior in controlling the overall complication rate and prolonging the long-term survival rate. Conclusion Current evidence suggests that endoscopic third ventriculostomy is superior to ventriculal peritoneum shunt in reducing the overall complications and prolonging the long-term survival rate, but there is no significant difference in short-term survival rate between the two methods. The effectiveness of the two operational methods for hydrocephalus caused by all specific reasons still has to be further proved by more high-quality, multi-centered and double-blind RCTs.
Objective To summarize the experience of laparoscopic ventriculo-peritoneal shunt for treating patients with hydrocephalus. Methods Twenty-two cases with hydrocephalus were treated with laparoscopic ventriculo-peritoneal shunt.The drainage-tube was put into the right liver-diaphragm interspace in 9 patients and inserted into the pelvic kidney in the others. Postoperative complications, ameliorating conditions of intracranial hypertension and recovery conditions of these patients were observed. Results All the operations were succeeded and the patients got amelioration of intracranial hypertension.No complication correlating with laparoscopic surgery occured. Conclusion Laparoscopic ventriculo-peritoneal shunt have the advantages of less invasive,better intra-abdominal view and more rapid recovery than conventional laparotomy. It’s a safe and feasible method which is worth of wide using.
目的 探讨经胼胝体-穹窿间入路切除第三脑室肿瘤术后，近期下丘脑反应的发生情况及相关因素，为防治第三脑室肿瘤术后下丘脑反应提供参考。 方法 回顾分析2003年1月－2008年12月经胼胝体-穹窿间入路切除的78例第三脑室肿瘤患者手术后近期（1个月内）下丘脑反应的发生情况，并将其按照肿瘤部位、病理性质、大小、血供、手术切除程度进行分类统计，用SPSS 13.0软件logistic 回归分析影响这些并发症的因素。 结果 78例术后下丘脑反应37例，发生率47.4%；死亡5例，下丘脑反应病死率为13.5%（5/37）。其中电解质糖代谢紊乱33例（42.3%），尿崩症27例（34.6%），激素水平低下16例（20.5%），高热6例（7.7%）。好转痊愈率：激素水平低下43.7%，其余均＞70%。第三脑室前部颅咽管瘤术后最容易发生下丘脑反应（P＜0.05）。 结论 经胼胝体-穹窿间入路切除第三脑室肿瘤术后近期存在程度不同的下丘脑反应，其发生与肿瘤部位、病理性质有密切关系。经积极治疗，大部分下丘脑反应能在术后1个月内好转甚至痊愈。
【摘要】 目的 研究改良Paine点侧脑室额角穿刺的解剖基础及临床应用。 方法 利用MRI模型的构建，模拟改良Paine点穿刺侧脑室额角。测量穿刺距离、角度及其对Broca语言功能区和尾状核的影响。改良Paine点（Pm点）比Paine点高1 cm，更加远离Broca语言功能区，穿刺时需要与轴面夹角20°向下，可以越过尾状核头从侧脑室额角上壁进入脑室；与矢状面夹角约70°向下、冠状面夹角约20°向后穿刺。从皮层计算进针4.0~5.5 cm可进入侧脑室额角。 结果 同期7例颅内动脉瘤患者术中应用Pm点穿刺成功，术后无语言功能障碍，复查头颅CT无穿刺道及尾状核头出血现象。 结论 Pm点法定位方法简便准确，能避免Broca语言功能区和尾状核头部的损伤，有一定临床应用推广价值。【Abstract】 Objective To analyze the anatomic characteristics and clinical application of modified Paine entry point (Pm) for lateral ventricular puncture through pterional approach. Methods We simulated the modified Paine entry point for lateral ventricular frontal horn puncture by reconstructing the model of MRI. Distance and angles of the puncture path were measured to evaluate the influence upon the language areas of Broca and the head of the caudate nucleus. The Pm point is 1 cm higher than the Paine point, so it is more far away from the Broca area. The direction of the puncture path should be 20° downward with the axial plane, 70° downward with the sagittal plane and 20° backward with the coronal plane. The catheter was inserted into the ventricle 4.0 to 5.5 cm deep to the cortex. Results Seven patients with intracranial aneurysms underwent ventricular puncture successfully through the Pm point in operation. None of them suffered language dysfunction or hemorrhage lesions in the caudate nucleus by the computed tomography. Conclusion The modified Paine entry point can be located accurately and has the clinical value for preventing damage of the Broca area and the caudate nucleus.
目的:探讨内镜在梗阻性脑积水治疗中的临床应用价值。方法:将我院80例梗阻性脑积水患者随机分为治疗组及对照组,对照组患者采用分流术,治疗组患者采用神经内镜下三脑室底造瘘术。结果:治疗组均造瘘成功,无中转分流术。手术时间治疗组明显短于对照组,术后并发症例数也明显少于对照组,差异有统计学意义(Plt;0.05),术后症状缓解率差异无统计学意义(Pgt;005)。两组患者均获随访,时间6～12个月,症状均有锁缓解,复查CT或MRI见脑室均有不同程度缩小.结论:ETV治疗梗阻性脑积水符合当今神经外科微创原则,疗效确切,手术时间短、脑暴露少、对组织损伤小,手术费用降低,并发症少,值得推广。