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 establish and evaluate a hydrocephalus model in dogs. Methods Twelve healthy adult male mongrel dogs (weight, 10-15 kg) were randomly divided into the control group (n=6) and the experimental group (n=6). All the dogs were given CT and neurological examination to exclude congenital ventricular enlargement and neurological abnormity before they received hydrocephalus induction. Surgical procedures included the exposing of the foramen magnum area, the opening of the atlantooccipita anadesma, and the injecting of silicone oil (0.3 ml/kg) into the fourth ventricle through a silicone tube. Normal saline was injected in the control group. The Tarlov neurological fitness assessment and the Evan’s ratio were used to evaluatethe degree of hydrocephalus at 3, 14 and 56 days after operation. Results In the experimental group, the dogs were dull and unsteady in walking,and they drank and ate less. The lateral ventricle began to expand 3 days afteroperation, and then the temple horn of the lateral ventricle and the third ventricle were also affected 14 days after operation. The ventricles were enlarged progressively after operation. The Tarlov scores measured at 3, 14 and 56 days afteroperation had a significant difference at the same time point between the control group(5.83±0.75，6.50±0.55，6.00±0.63) and the experimental group (4.00±0.89，4.83±1.17，4.50±1.05，P＜0.01), but had no significant difference within the same group at different time points (P＞0.05). The Evan’s ratios measured at 3, 14 and 56 days after operation were 0.33±0.04,0.39±006，0.44±0.03，respectively,in the experimental group; and were 0.27±0.06，0.25±0.09, 0.26±0.05,respectively,in the control group. There was a significant difference atthe same time point between the two groups, and at different time points within the experimental group (P＜0.05).Conclusion The dog model of hydrocephalus induced by the injecting of silicone oil into the fourth ventricle has a highsuccess rate, and the model is appropriate for the studies on diagnosis and therapy of hydrocephalus.
目的:探讨儿童颅骨生长性骨折(GSF)的形成机制,诊断和治疗。方法:对我院15例GSF患儿的临床资料进行回顾性分析。结果:15例患儿均有颅脑外伤史,致颅骨线性骨折,骨折线进行性增宽,颅骨缺损,术中均发现有硬脑膜破裂。15例患儿均行手术治疗,3例患儿手术后出现脑积水并予脑室-腹腔(V-P)分流术。结论:颅骨骨折和硬脑膜破裂是发生GSF最重要的因素;患儿发生颅骨线性骨折后应定期复查头部CT,一旦确诊为GSF须行颅骨成形手术治疗;儿童GSF手术后出现的脑积水行V-P分流术治疗效果较好。
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。
ObjectiveTo measure the ventricular size and extracerebral space of normal neonates and infants, and discuss the diagnostic criteria of MRI in external hydrocephalus. MethodsNeonates and infants suspected to have brain diseases treated in our hospital from January 2009 to January 2013 were selected, and through strict inclusion and exclusion, 671 neonates and infants within 3 years of age and without neural system disease were included in our study. They were divided into 9 age groups. The ventricular size was measured on T1WI, that was bifrontal index, bibody index and the ratio of ventricle and cranial cavity diameter (VT/ST). And the width of extracerebral space, intercerebral fissure and sylvian fissure were measured on T2WI. A total of 149 neonates and infants with external hydrocephalus underwent the same measurement, and the changes in external hydrocephalus were dynamically observed. ResultsVentricular volume increased gradually with age, but the bifrontal index[(0.32±0.05) mm] and the ratio of VT/ST (14.09%±1.56%) were relatively constant. The extracerebral space widened with age during 0-6 months, after which it began to narrow, and the age of 3-6 months was the turning point for this trend. The frontal subarachnoid, intercerebral fissure, and sylvian fissure of infants with external hydrocephalus were wider than standard values of the corresponding age group, and the ratio of VT/ST was less than 15%. ConclusionThe standard values of ventricular size and extracerebral space of each age group provide the basis for the evaluation of brain development. Among them, the bifrontal index and the ratio of VT/ST are reliable indicators to determine the ventricular size. Subarachnoid depth, intercerebral fissure, and the ratio of VT/ST play an important role in the diagnosis of EH. But for secondary external hydrocephalus, early treatment should be carried out.
ObjectiveTo analyze safety and feasibility of transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting. MethodsThe clinical data of 36 patients who diagnosed as hydrocephalus underwent ventriculoperitoneal shunting from May 2013 to August 2015 in this hospital were collected. Twelve patients were performed transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting (laparoscopy group) and 24 patients were performed laparotomy ventriculoperitoneal shunting (laparotomy group). The abdominal operation time, postoperative exhaust time, postoperative hospital stay, postoperative pain score, and postoperative complications rate were compared between the laparoscopy group and the laparotomy group. ResultsAll the operations were completed successfully. Compared with the laparotomy group, the abdominal operation time (P < 0.05), postoperative exhaust time (P < 0.05), and postoperative hospital stay (P < 0.05) were significantly shorter, the postoperative pain score was significantly less (P < 0.05) in the laparoscopy group. The postoperative complications rate had no significant difference between the laparoscopy group and the laparotomy group (P > 0.05). ConclusionsThe preliminary results of limited cases in this study show that transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting is safe and feasible, with better cosmetic. more comparative studies or randomized controlled trials are required to make a confirmed conclusion.