分流梗阻是治疗脑积水分流失败的常见原因。传统上认为瓣膜闭塞起源于升高的CSF蛋白或细胞成分。虽然详细的证据是稀缺和矛盾的。因此,这项研究旨在检查CSF蛋白和细胞计数作为瓣膜阻塞的危险因素。
我们回顾性检查了274例因脑积水在2009年至2018年期间接受分流术的患者,并进行了至少1年的随访。年龄,脑积水的病因,阀门类型,发生修订,分析了分流插入和翻修手术时的翻修原因以及CSF蛋白和细胞计数.
274例患者中有32例(11.7%)因瓣膜闭塞而需要翻修手术。平均修正时间为143天。CSF白细胞(WBC)计数而不是蛋白质与瓣膜总体闭塞相关。在所有瓣膜阻塞患者中,25%的脑脊液蛋白水平在正常范围内,而13.6%的患者显示CSF蛋白水平显著升高,无瓣膜阻塞的证据.在初次插入(早期闭塞)的90天内,分流翻修时持续升高的CSF蛋白水平与瓣膜阻塞显着相关。先天性畸形和出血后患者在闭塞组中明显过多。尤其是早期闭塞组。
病理性CSF值,如白细胞计数和持续升高的蛋白质水平是早期瓣膜阻塞的危险因素。晚期梗阻的发生与脑脊液正常值无关。婴儿特别容易出现早期和晚期瓣膜阻塞。分流插入时的CSF蛋白水平不能预测瓣膜闭塞。
Shunt obstruction is a common cause of shunt failure in the treatment of hydrocephalus. Valve occlusion is traditionally believed to originate from elevated CSF protein or cellular components, although detailed evidence is scarce and contradictory. Therefore, this study aimed to examine CSF protein and cell count as risk factors for valve obstruction.
We retrospectively examined 274 patients who underwent shunt placement for hydrocephalus between 2009 and 2018 and had at least 1 year follow-up. Age, aetiology of hydrocephalus, valve type, occurrence of revision, reason for revision and CSF protein and cell count at the time of shunt insertion and revision surgery were analysed.
Thirty-two of 274 patients (11.7%) required revision surgery due to valve occlusion. Mean time to revision was 143 days. CSF white blood cell (WBC) count but not protein was associated with valve occlusion overall. Of all obstructed valve patients, 25% showed CSF protein level within the normal range, whereas 13.6% of the patients overall showed greatly elevated CSF protein level without evidence of valve obstruction. Persistently elevated CSF protein level at the time of shunt revision was significantly associated with valve obstruction within 90 days of initial insertion (early occlusion). Children with congenital malformations and post-haemorrhagic patients were significantly overrepresented in the occlusion group, particularly in the early occlusion group.
Pathological CSF values such as WBC count and persistently elevated protein level serves as a risk factor for early valve obstruction. Late obstruction occurs independent of normal CSF values. Infants are particularly prone to early and late valve obstructions. CSF protein level at shunt insertion is not predictive of valve occlusion.