RESUMO
Objective:To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow-up.Methods:A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively.There were 16 cases with SEHS, 11 of whom were male and 5 were female.The age ranged from 3 months to 13 years (median: 2.5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods(pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed.The pressure adjustment treatment was to increase the by 10-20 mmH 2O (1 mmH 2O=0.009 8 kPa) each time and the patients were followed up 2-4 weeks after the adjustment.If SEHS didn′t improve according to the follow-up results, pressure regulation combined with drilling and drainage was recommended. Results:Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below.Eleven cases were treated by pressure regulation only, and 5 cases who were all aged ≤3 years received pressure regulation combined with drilling and drainage.Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case.Fourteen cases were asymptomatic.The time from shunt operation to the occurrence of SEHS was ≤1 month in 5 cases, who were all cured by pressure regulation only.SEHS occurred in 5 cases >1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with dri-lling and drainage.Three cases had SEHS>3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4.5 months, 7.5 months, and 25.0 months, respectively.The time from the occurrence of SEHS to the last reexamination with no SEHS detected was ≤1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2.0 months, 3.0 months, 7.0 months and 8.0 months, respectively.Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured.Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median: 39.0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median: 158.2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side.Conclusions:SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms.SEHS mostly occurs within 6 months after operation, especially within 3 months.SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only.Therefore, SEHS can be cured by pressure regulation only by shortening follow-up and identifying SEHS early after shunt operation.This will also reduce the probability that patients require the drilling and drainage operation.
RESUMO
CSF shunting procedures are widely employed in the treatment of hydrocephalus and other disturbances of the dynamics of CSF such as a rachnoid cyst and syrinx. The relative simplicity of this operation with respect to other neurosurgical procedures is matched by a high incidence of complications. Many kinds of shunt devices have been developed to reduce complications. Yet, this operation frequently requires surgical revision. Traditional shunts were primarily designed to manage hydrocephalus by regulating intracranial pressure. Those devices, in some circumstances, can cause to underdrain or overdrain CSF and may need a surgical revision to adjust the pressure Authors have treated 28 patients with the disturbaces of CSF dynamics using pressuread justable valve system (Codman-Medos p rogrammable Hakim valve system). Two patients had arachnoid cysts and the others had hydrocephalus with various etiologies. Subdural hygroma was developed in 5 patients and underdrainage was observed in 9 patients on CT scan. By adjusting the pressure, Authors achieved clinical improvements without a need for surgical revision. The optimum pressure was 97.4+17.4mmHO for the patients with hydrocephalus with various etiologies in adults. In conclusion, the incidence of shunt revision by using this shunt device for the treatment of hydrocephalus and arachnoid cysts was decreased.