脑积水 脑积水(hydrocephalus)是指脑脊液循环障碍引起的颅内压增高和脑室扩大。 先天性脑积水也称婴儿脑积水—循环受阻、吸收障碍、或分泌过多形成头颅扩大、颅压增高、脑功能障碍。
脑脊液循环 主要由侧脑室和第三脑室脉络丛生成经室间孔——第三脑室经导水管——第四脑室(正中孔和侧孔)——蛛网膜下腔——蛛网膜颗粒吸收入上矢状窦。
正常人的脑脊液的分泌和吸收保持平衡,新生儿脑脊液总量50ml,成人150ml,成人每日分泌总量约500ml
脑积水的概念
引起脑积水的因素 脑脊液分泌过多 脑脊液的循环通路梗阻 脑脊液的吸收障碍
脑积水的病因 产伤后颅内出血 新生儿婴儿期脑膜炎 先天畸形1/4(Dandy-Walker,Chiairi) 原因不明1/4 肿瘤性少见
四脑室出口梗阻
脉络膜乳头状瘤
大脑大静脉瘤
小脑扁桃体下疝
脑积水的分类 非交通性脑积水 脑室系统梗阻 交通性脑积水 脑室以外部位梗阻
临床表现 出生6个月以内脑积水 头围增大 额顶凸出、囟门扩大隆起 头发稀少 静脉怒张 面颅<头颅 落日症 中脑受累-眼球运动障碍或瞳孔反射异常
脑积水辅助检查 X-线颅骨摄片 CT MRI
脑积水的治疗
脑积水的治疗 脑积水是否需手术,从三个方面来考虑 脑室内压力增高 脑脊液量增多 脑室系统扩张 至今手术治疗仍然是治疗婴儿脑积水最主要的方法,根据脑积水影像学的检查,交通性脑积水选择安装分流装置的分流手术,梗阻性脑积水可选择,脑室镜下三脑室造瘘术
1898年Ferguson提出脑积水外科治疗。脑脊液分流术是一种较为合理的成功的手术。 公认效果好的有: 侧脑室—心房分流术 侧脑室—腹腔分流术 脑室镜下三脑室造瘘术
解除梗阻手术 Dandy-Walker Arnold-Chiari畸形
建立旁路引流 Torkildsen手术 第三脑室造瘘术
分流术 腰脊髓蛛网膜下腔-腹腔分流术 脑室体腔分流术 脑室腹腔分流 脑室心房分流术
Normally within the brain there are some cavities named ventricles, where a liquid known as Cerebrospinal Fluid (CSF) is produced. The purpose of this is to protect the brain and spinal cord, acting as a shock absorber. It also carries away disposed materials. The CSF circulates from the ventricles towards a space that exists between the brain and the membranes (meninges) that surround it, from where it is "eliminated", into the blood stream. Hydrocephalus... In the individual with hydrocephalus, the fluid does not drain away properly, but accumulates. In an infant, the seams of the skull have not yet fused, so the skull gets bigger as the fluid accumulates.
This baby recovers after having surgery to install a shunt. Hydrocephalus... A miniature pump called a shunt is placed in the head to remove off excess fluid. This baby recovers after having surgery to install a shunt.