Cao Hongbin,Cao Hongxu,Guo Genrui,et al.Application of a parieto-occipital ventricular catheter ruler for ventriculoperitoneal shunting[J].Journal of Clinical Pediatric Surgery,2019,18(08):703-706.[doi:10.3969/j.issn.1671-6353.2019.08.017]
经枕角脑室穿刺定位器在脑室腹腔分流术中的应用
- Title:
- Application of a parieto-occipital ventricular catheter ruler for ventriculoperitoneal shunting
- Keywords:
- Hydrocephalus; Ventriculoperitoneal Shunt; Ventricular Puncture; Ventricular Catheter; Localizer
- 分类号:
- R651.1+1;R742.7
- 摘要:
- 目的 目前经枕角脑室穿刺是儿童脑积水脑室腹腔分流术中采用的主要穿刺路径，但经枕角穿刺较经额角穿刺困难，易出现分流管脑室端位置不满意等情况。本文介绍一种经枕角脑室穿刺定位器，并初步应用于临床，观察其效果。方法 2016年5月至2017年11月，采用经枕角脑室穿刺定位器辅助行脑室腹腔分流术治疗儿童脑积水患儿36例，其中男童26例，女童10例，年龄1个月至10岁，平均年龄19个月。先天性脑积水23例，肿瘤引起的脑积水7例，出血引起的脑积水3例，感染引起的脑积水3例。脑室穿刺绝大部分采用经右侧枕角入路，采用经枕角脑室穿刺定位器辅助分段穿刺法行脑室穿刺。结果 所有患儿均1次穿刺成功，无术中并发症发生，无深部血管损伤出血，无意外的神经损伤。位置满意率100%。随访18个月，均无脑室端梗阻发生。结论 经枕角脑室穿刺定位器能显著提高脑室腹腔分流术中脑室端位置满意率。
- Abstract:
- Objective The parieto-occipital approach is a major approach of ventriculoperitoneal shunting for pediatric hydrocephalus.However,it is more difficult than the frontal approach and more likely to make an inappropriate ventricular catheter position.A parieto-occipital ventricular catheter ruler was applied for ventriculoperitoneal shunting in children and the clinical efficacies were tested.Methods Retrospective analysis was performed for 36 children with hydrocephalus undergoing ventriculoperitoneal shunting via a parieto-occipital ventricular catheter ruler from May 2016 to November 2017.There were 26 boys and 10 girls with a mean age of 19(1-120) months.The causes were congenital (n=23),brain-tumor-related (n=7),post-hemorrhagic (n=3) and post-infective (n=3).The parieto-occipital ventricular catheter ruler was adopted with a 2-segmented puncture through a right parieto-occipital approach.Results All cases were successfully punctured on one try.There was no onset of intraoperative complication,deep vascular injury or accidental nervous injury.The appropriate ventricular catheter position rate was 100%.No ventricular catheter obstruction occurred during a follow-up period of 18 months.Conclusion The parieto-occipital ventricular catheter ruler can significantly improve the appropriate ventricular catheter position rate during ventriculoperitoneal shunting.
参考文献/References:
1 王贤书,张晓茹,杨志国,等.脑室腹腔分流术治疗婴儿脑积水120例[J].临床小儿外科杂志,2011,10(2):105-106.DOI:10.3969/j.issn.1671-6353.2011.02.008.Wang XS,Zhang XR,Yang ZG,et al.Ventriculo-peritoneal shunt surgery of infants hydrocephalus:a clinical research[J].J Clin Ped Sur,2011,10(2):105-106.DOI:10.3969/j.issn.1671-6353.2011.02.008.
2 Kemp J,Flannery AM,Tamber MS,et al.Pediatric hydrocephalus:systematic literature review and evidence-based guidelines.Part 9:Effect of ventricular catheter entry point and position[J].J Neurosurg Pediatr,2014,14 Suppl 1:72-76.DOI:10.3171/2014.7.PEDS14329.
3 Whitehead WE,Riva-Cambrin J,Wellons JC,et al.Factors associated with ventricular catheter movement and inaccurate catheter location:post hoc analysis of the hydrocephalus clinical research network ultrasound-guided shunt placement study[J].J Neurosurg Pediatr,2014,14(2):173-178.DOI:10.3171/2014.5.PEDS13481.
4 Coulson NK,Chiarelli PA,Su DK,et al.Ultrasound stylet for non-image-guided ventricular catheterization[J].J Neurosurg Pediatr,2015,16(4):393-401.DOI:10.3171/2015.2.PEDS14387.
5 Beez T,Sarikaya-Seiwert S,Steiger HJ,et al.Real-time ultrasound guidance for ventricular catheter placement in pediatric cerebrospinal fluid shunts[J].Childs Nerv Syst,2015,31(2):235-241.DOI:10.1007/s00381-014-2611-4.
6 Wilson TJ,Stetler WR,Al-Holou WN,et al.Comparison of the accuracy of ventricular catheter placement using freehand placement,ultrasonic guidance,and stereotactic neuronavigation[J].J Neurosurg,2013,119(1):66-70.DOI:10.3171/2012.11.JNS111384.
7 Sarrafzadeh A,Smoll N,Schaller K.Guided (VENTRI-GUIDE) versus freehand ventriculostomy:study protocol for a randomized controlled trial[J].Trials,2014,15(5):478.DOI:10.1186/1745-6215-15-478.
8 Thomale UW,Knitter T,Schaumann A,et al.Smartphone-assisted guide for the placement of ventricular catheters[J].Childs Nerv Syst,2013,29(1):131-139.DOI:10.1007/s00381-012-1943-1.
9 Yamada SM,Kitagawa R,Teramoto A.Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt[J].J Clin Neurosci,2013,20(1):99-101.DOI:10.1016/j.jocn.2012.01.041.
10 Levitt MR,O’Neill BR,Ishak GE.Image-guided cerebrospinal fluid shunting in children:catheter accuracy and shunt survival[J].J Neurosurg Pediatr,2012,10(2):112-117.DOI:10.3171/2012.3.PEDS122.
11 Gilard V,Magne N,Gerardin E.Comparison of electromagnetic neuronavigation system and free-hand method for ventricular catheter placement in internal shunt[J].Clin Neurol Neurosurg,2017,158:93-97.DOI:10.1016/j.clineuro.2017.05.007.
12 Coulson NK,Chiarelli PA,Su DK,et al.Ultrasound stylet for non-image-guided ventricular catheterization[J].J Neurosurg Pediatr,2015,16(4):393-401.DOI:10.3171/2015.2.PEDS14387.
13 Huyette DR,Turnbow BJ,Kaufman C,et al.Accuracy of the freehand pass technique for ventriculostomy catheterplacement:retrospective assessment using computed tomography scans[J].J Neurosurg,2008,108(1):88-91.DOI:10.3171/JNS/2008/108/01/0088.
14 Howard MA,Srinivasan J,Bevering CG,et al.A guide to placement of parietooccipital ventricular catheters.Technical note[J].J Neurosurg,1995,82(2):300-304.DOI:10.3171/jns.1995.82.2.0300.
相似文献/References:
[1]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(08):0.
[2]王贤书 张晓茹 杨志国 程征海 岳芳 曹红宾 李德泽. 脑室腹腔分流术治疗婴儿脑积水120例 [J].临床小儿外科杂志,2011,10(02):105.
[3]张迪 冀园琦 张建. 婴儿脑积水合并感染的危险因素分析[J].临床小儿外科杂志,2013,12(05):384.
[4]汪凤华 邓志坚 梁建华. 腹腔端外引流法治疗脑室腹腔分流术后感染5例[J].临床小儿外科杂志,2014,13(04):314.
[5]吴水华,沈沉浮,陈朝晖,等.巴德（Ｂｉｒｄ）植入式输液港在婴幼儿急性梗阻性脑积水治疗中的应用[J].临床小儿外科杂志,2017,16(06):592.
[6]刘祎,秦齐,张佳,等.婴幼儿脑室出血后脑积水的危险因素分析[J].临床小儿外科杂志,2024,(03):242.[doi:10.3760/cma.j.cn101785-202208008-008]
Liu Yi,Qin Qi,Zhang Jia,et al.Analysis of risk factors of hydrocephalus after intraventricular hemorrhage in infants[J].Journal of Clinical Pediatric Surgery,2024,(08):242.[doi:10.3760/cma.j.cn101785-202208008-008]
[7]马宏图,周建军,纪文元,等.两种手术治疗结核性脑膜脑炎并发脑积水的效果分析[J].临床小儿外科杂志,2024,(09):861.[doi:10.3760/cma.j.cn101785-202304073-011]
Ma Hongtu,Zhou Jianjun,Ji Wenyuan,et al.Comparison and analysis of the effectiveness of two surgical treatments for tuberculous meningoencephalitis complicated with hydrocephalus[J].Journal of Clinical Pediatric Surgery,2024,(08):861.[doi:10.3760/cma.j.cn101785-202304073-011]
备注/Memo
收稿日期:2018-01-15。
基金项目:河北省医学科学研究重点课题计划（编号：20170383）
通讯作者:王贤书,Email:sjxwk99@163.com