在新生儿后出血性水脑病的管理中使用 Ventriculosubgaleal shunts:技术说明

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Cristina Bleil¹, Francesca Vitulli^2,3, Asfand Baig Mirza¹

¹Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

|August 16, 2023

概括

一种经过修改的心室下关节 (VSGS) 技术,创造了远离手术伤口的口袋,减少了脑脊液 (CSF) 泄漏和过早产婴儿患有后出血性水脑病的感染.

科学领域:

新生儿手术新生儿手术
儿科神经外科儿科神经外科
过早产生的并发症

背景情况:

生殖母体/腹腔内出血 (GMIVH) 是早产婴儿的一种严重并发症.
严重的GMIVH可以导致对瘤性出血性心脏病发作和水脑.
新生儿后出血性水头 (nPHH) 的管理往往需要暂时的脑脊液 (CSF) 转移,因为永久的分流在早期的高失败率.

研究的目的:

描述一个修改的技术,用于心室下关节 (VSGS) 插入.
评估这种修改技术在降低CSF泄漏和感染率方面的有效性.
评估VSGS的结果作为nPHH的定时程序.

主要方法:

在2014年9月至2023年2月期间接受VSGS插入的患者的回顾性分析.
一种修改后的VSGS技术的描述,其中离外科手术伤口创建了离外科手术伤口的分离口袋.
结果的比较,包括CSF泄漏,感染率,以及需要永久的分流转换.

主要成果:

包括20名早产婴儿 (平均妊娠年龄为31周+4天).
经过修改的技术导致低的CSF泄漏率 (2名患者) 和没有先前存在的中枢神经系统感染的患者没有VSGS相关的感染.
75%的患者需要在平均72天后转换为永久的腹腔关突变 (VPS).

结论:

修改后的VSGS手术方法有效降低了CSF泄漏和随后的感染率.
将VSGS口袋远离手术伤口是提高安全性的关键因素.
这种修改后的技术为新生儿后出血性头症提供了一个有希望的缓解解决方案.

关键词:

在CSF泄漏.大脑脊髓液感染生殖基质矩阵是生殖基质矩阵.腹腔室内出血腹腔室内出血过早生育过早生育腹腔上腺突变 (Ventriculoperitoneal shunt) 已经开始使用.

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