Neurological Surgery 脳神経外科37巻8号

2009年08月発行

総説

先天性水頭症の診断と治療

著者： 山崎麻美¹ 埜中正博¹

所属機関： ¹独立行政法人国立病院機構大阪医療センター脳神経外科

ページ範囲：P.729 - P.740

Ⅰ．はじめに

　先天性水頭症は胎児超音波診断機器の進歩により，そのほとんどが胎児期に診断されるようになり，胎児期水頭症とほぼ同義になりつつある．胎児期水頭症のより正確な診断は，今後も大きな課題である．それでも，先天性水頭症が幼児期後期になって見つかることもあり，そのときの手術適応については次の課題である．治療の問題点は，先天性水頭症の治療選択として第三脳室底開窓術（endoscopic third ventriculostomy：ETV）の適応，シャント合併症のなかの大きな問題である感染の回避，slit ventricle syndromeの治療，そしてシャント手術をした水頭症の予後についてなどである．ここでは先天性水頭症の診断と治療の中で，これらの最近の話題について述べる．

参考文献

1）Albright AL, Tyler-Kabara E：Slit-ventricle syndrome secondary to shunt-induced suture ossification. Neurosurgery 48：764-770, 2001

2）Baskin JJ, Manwaring KH, Rekate HL：Ventricular shunt removal：the ultimate treatment of the slit ventricle syndrome. J Neurosurg 88：478-484, 1998

3）Benabarre A, Ibáñez J, Boget T, Obiols J, Martínez-Aran A, Vieta E：Neuropsychological and psychiatric complications in endoscopic third ventriculostomy：a clinical case report. J Neurol Neurosurg Psychiatry 71：268-271, 2001

4）Bilginer B, Oguz KK, Akalan N：Endoscopic third ventriculostomy for malfunction in previous shunted infants. Childs Nerv Syst 25：683-688, 2009

5）Butler WE, Khan SA：The application of controlled intracranial hypertension in slit ventricle syndrome patients with obstructive hydrocephalus and shunt malfunction. Pediatr Neurosurg 35：305-310, 2001

6）Buxton N：Punt JSubtemporal decompression：the treatment of noncompliant ventricle syndrome. Neurosurgery 44：513-518, 1999

7）Casey AT, Kimmings EJ, Kleinlugtebeld AD, Taylor WA, Harkness WF, Hayward RD：The long-term outlook for hydrocephalus in childhood：A ten-year cohort study of 155 patients. Pediatr Neurosurg 27：63-70, 1997

8）Choux M, Genitori L, Lang D, Lena G：Shunt implantation：reducing the incidence of shunt infection. J Neurosurg 77：875-880, 1992

9）Cinalli G, Saint-Rose C, ChunmasP, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D：Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90：448-454, 1999

10）Cowan JA, McGirt MJ, Woodworth G, Rigamonti D, Williams MA：The syndrome of hydrocephalus in young and middle-aged adults (SHYMA). Neurol Res 27：540-547, 2005

11）Drake JM, Iantosca MR：Management of pediafric hydrocephalus with shunt. Pediafric Hearosurgery, eds McLone DG et al, WB Saunders, 2001, pp505-522

12）Epstein F, Lapras C, Wisoff JH：‘Slit-ventricle syndrome’：etiology and treatment. Pediatr Neurosci 14：5-10, 1988

13）Falip C, Blanc N, Maes E, Zaccaria I, Oury JF, Sebag G, Garel C：Postnatal clinical and imaging follow-up of infant with prenatal isolate mild ventriculomegaly：a series 101 cases. Prenatal Radiol 37：981-989, 2007

14）Gaglioti P, Danelson D, Bontempo S, Mombro M, Cardaropoli S, Todros T：Fetal cerebral ventriculomegaly：out come in 176 cases. Ultrasound Obstet Gynecol 25：372-377, 2005

15）Garton HJ, Kestle JR, Drake JM：Predicting shunt failure on the basis of clinical symptoms and signs in children. J Neurosurg 94：202-210, 2001

16）Gorayeb RP, Cavalheiro S, Zymberg ST：Endoscopic third ventriculostomy in children younger than 1 years of age. J Neurosurg (Pediatrics 5) 100：427-429, 2004

17）Hader WJ, Walker RL, Myles ST, Hamilton M：Complication of endoscopic third ventriculostomy in previous shunted patients. Neurosurgery 63：170-177, 2008

18）Hoppe-Hirsch E, Laroussinie F, Brunet L, Sainte-Rose C, Renier D, Cinalli G, Zerah M, Pierre-Kahn A：Late outcome of the surgical treatment of hydrocephalus. Childs Nerv Syst. Mar 14(3)：97-99

19）Kanev PM, Sheehan JM：Reflections on shunt infection. Pediatr Neurosurg 39：285-290, 2003

20）Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, Piatt J, Haines S, Schiff S, Cochrane D, Steinbok P, MacNeil N：Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33：230-236 ,2000

21）Kim SK, Wang KC, Cho BK：Surgecal outcome of pediatric hydrocephalus treated by endoscopic third ventriculostomy：prognostic factors and interpretation of postoperative neuroimaging. Childs Nerv Syst 16：161-169, 2000

22）Kulkarni AV, Drake JM, Lamberti-Pasculli M：Cerebrospinal fluid shunt infection：a prospective study of risk factors. J Neurosurg 94：195-201, 2001

23）Le H, Yamini B, Frim DM：Lumboperitoneal shunting as a treatment for slit ventricle syndrome. Pediatr Neurosurg 36：178-82, 2002

24）McGirt MJ, Leveque JC, Wellons JC 3rd, Villavicencio AT, Hopkins JS, Fuchs HE, George TM：Cerebrospinal fluid shunt survival and etiology of failures：a seven-year institutional experience. Pediatr Neurosurg 36：248-255, 2002

25）McLaurin RL, Olivi A：Slit-ventricle syndrome：review of 15 cases Pediatr Neurosci 13：118-124, 1987

26）Mohanty A, Bisways A, Satish S, Praharaj SS：Satry KVR Treatment options for Dandy-Walker malformation. J Neurosurg (5suppl Pediatrics) 105：348-356, 2006

27）森竹浩三，山崎麻美，森　惟明，菊池晴彦：胎児期水頭症─疫学調査20年の軌跡．No Shinkei Geka 36：7-24, 2008

28）Nicolaides KH, Berry S, Snijders RJ, Thorpe-Beeston JG, Gosden C：Fetal lateral cerebral ventriculomegaly：associated malformations and chromosomal defects. Fetal Dign Ther 5：5-14, 1990

29）Nishiyama K, Mori H, Tanaka R：Changes in cerebrospinal fluid hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicationg hydrocephalus. J Neurosurg 98：1027-1031, 2003

30）Obana WG, Raskin NH, Cogen PH, Szymanski JA, Edwards MS：Antimigraine treatment for slit ventricle syndrome. Neurosurgery 27：760-763, 1990

31）O’Brien DF, Javadpor M, Collins DR, Spennato P, Mallucci CL：Endoscopic third ventriculostomy：an outcome analysis of primary cases and procedure performed after ventricular peritoneal shunt malfunction. J Neurosurg (5suppl Pediatrics) 103：393-400, 2005

32）Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, Tsugane R, Sato O：Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg 92：933-940, 2000

33）大井静雄．5.水頭症Ⅲ短絡術後の諸問題．In：牧　豊，編．小児神経外科の進歩と展望．1版．東京：にゅーろん社，1988, pp117-123

34）Pople IK, Bayston R, Hayward RD：J Neurosurg 77：29-36, 1992

35）Rekate HL：Longstanding overt ventriculomegaly in adults：pitfalls in treatment with endoscopic third ventriculostomy. Neurosurg Focus. 2007 Apr 15；22：E6.

36）Rekate HL：Selecting patients for endoscopic third ventriculostomy. Neurosurg Clin N Am 15：39-49, 2004

37）Rekate HL：Treatment of hydrocephalus Principle and practice of pediatric neurosurgery. eds. Albright AL et al, Thieme, 1999 pp47-73

38）Rekate HL, Wallace D：Lumboperitoneal shunts in children. Pediatr Neurosurg 38：41-46, 2003

39）Renier D, Sainte-Rose C, Pierre-Kahn A, Hirsch JF：Prenatal hydrocephalus：outcome and prognosis. Childs Nerv Syst 4：213-22, 1988

40）Sainte-Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ, Humphreys RP, Hendrick EB：Mechanical complications in shunts. Pediatr Neurosurg 17(1)：2-9, 1991-1992

41）Sakamoto H, Kitano S：Reexpandability of the ventricular system of hydrocephalic children in the event of shunt occlusion. Childs Nerv Syst 22：517-522, 2006

42）Sgourous S, Kulkaharani AV：Constantini S The international infant hydrocephalus study：concept and rational. Childs Nerv Syst 22：338-345, 2005

43）Sood S, Barrett RJ, Powell T, Ham SD：The role of lumbar shunts in the management of slit ventricles：does the slit-ventricle syndrome exist?. J Neurosurg 103(2 Suppl)：119-123, 2005

44）胎児期水頭症診断と治療ガイドライン編集委員会：胎児期水頭症診断と治療ガイドライン，金芳堂，京都，2005, pp1-5

45）Teo C, Jones R：Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25：57-63, 1996

46）Tuli S, Tuli J, Drake J, Spears J：Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg 100 (5 Suppl Pediatrics)：442-446, 2004