Neurological Surgery 脳神経外科50巻2号

2022年03月発行

特集 水頭症—脳脊髄液動態への理解と治療に迫る Ⅲ水頭症の治療

長期シャント患者における合併症と治療法

著者： 朴永銖¹²

所属機関： ¹奈良県立医科大学脳神経外科 ²奈良県立医科大学附属病院小児センター

ページ範囲：P.393 - P.410

Point
・シャント手術の合併症として，術後早期にはシャント感染が問題となるが，その後長期にわたりさまざまな合併症が生じるリスクがある．
・シャント機能不全による水頭症の急速な進行悪化は，時に生命予後にかかわることを忘れてはならない．
・孤立性脳室やスリット脳室は特殊なシャント関連病態であり，その治療は容易ではない．
・近年，神経内視鏡的第三脳室底開窓術を併用したシャント離脱（抜去）が試みられるようになっているが，適応は慎重に検討すべきであり，綿密な治療計画が求められる．

参考文献

1）Drake JM, et al：CSF shunts 50 years on--past, present and future. Childs Nerv Syst 16：800-804, 2000

2）Kulkarni AV, et al；Canadian Pediatric Neurosurgery Study Group：Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 6：310-315, 2010

3）Kulkarni AV, et al：Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 7：143-146, 2011

4）Sainte-Rose C, et al：Mechanical complications in shunts. Pediatr Neurosurg 17：2-9, 1991-1992

5）Rohde V, et al：First experiences with an adjustable gravitational valve in childhood hydrocephalus. J Neurosurg Pediatr 3：90-93, 2009

6）Thomale UW, et al：Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit（proGAV）in pediatric neurosurgery. Childs Nerv Syst 29：425-431, 2013

7）Kaufmann AM, et al：Infection rates in standard vs. hydrogel coated ventricular catheters. Can J Neurol Sci 31：506-510, 2004

8）Mallucci CL, et al；BASICS Study collaborators：Antibiotic or silver versus standard ventriculoperitoneal shunts（BASICS）：a multicentre, single-blinded, randomised trial and economic evaluation. Lancet 394：1530-1539, 2019

9）Sainte-Rose C：Shunt obstruction：a preventable complication? Pediatr Neurosurg 19：156-164, 1993

10）Hanak BW, et al：Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg 52：381-400, 2017

11）Flannery AM, et al；Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force：Pediatric hydrocephalus：systematic literature review and evidence-based guidelines. Part 3：Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement. J Neurosurg Pediatr 14（Suppl 1）：24-29, 2014

12）Hayhurst C, et al：Effect of electromagnetic-navigated shunt placement on failure rates：a prospective multicenter study. J Neurosurg 113：1273-1278, 2010

13）Hermann EJ, et al：Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery. J Neurosurg Pediatr 10：327-333, 2012

14）Ventureyra EC, Higgins MJ：A new ventricular catheter for the prevention and treatment of proximal obstruction in cerebrospinal fluid shunts. Neurosurgery 34：924-926；discussion 926, 1994

15）Vinchon M, et al：Bowel perforation caused by peritoneal shunt catheters：diagnosis and treatment. Neurosurgery 58（1 Suppl）：ONS76-ONS82；discussion ONS76-ONS82, 2006

16）Boch AL, et al：Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter. J Neurosurg 88：975-982, 1998

17）Yamamoto S, et al：Calcific deposits on degraded shunt catheters：long-term follow-up of V-P shunts and late complications in three cases. Childs Nerv Syst 18：19-25, 2002

18）Kazan S, et al：Proof of the patent subcutaneous fibrous tract in children with V-P shunt malfunction. Childs Nerv Syst 16：351-356, 2000

19）Di Rocco C：Is the slit ventricle syndrome always a slit ventricle syndrome? Childs Nerv Syst 10：49-58, 1994

20）Rekate HL：The slit ventricle syndrome：advances based on technology and understanding. Pediatr Neurosurg 40：259-263, 2004

21）Roth J, et al：Modified bilateral subtemporal decompression for resistant slit ventricle syndrome. Childs Nerv Syst 27：101-110, 2011

22）Epstein F, et al：‘Slit-ventricle syndrome'：etiology and treatment. Pediatr Neurosci 14：5-10, 1988

23）Sakamoto H, et al：Clinical significance of ventricular size in shunted-hydrocephalic children. Acta Neurochir Suppl 71：357-359, 1998

24）Park DH, Yoon SH：The total calvarial transsutural distraction osteogenesis for 26 children with slit ventricle, craniosynostosis, or microcephaly after shunt operation. World Neurosurg 97：701-709, 2017

25）Sood S, et al：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

26）Oi S, Matsumoto S：Pathophysiology of aqueductal obstruction in isolated Ⅳ ventricle after shunting. Childs Nerv Syst 2：282-286, 1986

27）Ang BT, et al：Etiological differences between the isolated lateral ventricle and the isolated fourth ventricle. Childs Nerv Syst 22：1080-1085, 2006

28）Schulz M, et al：Endoscopic treatment of isolated fourth ventricle：clinical and radiological outcome. Neurosurgery 70：847-858；discussion 858-859, 2012

29）Cinalli G, et al：Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children. J Neurosurg 104（1 Suppl）：21-27, 2006

30）Liakos AM, et al：Hydrocephalus and the reproductive health of women：the medical implications of maternal shunt dependency in 70 women and 138 pregnancies. Neurol Res 22：69-88, 2000

31）Cusimano MD, et al：Ventriculoperitoneal shunt malfunction during pregnancy. Neurosurgery 27：969-971, 1990

32）Cusimano MD, et al：Management of pregnant women with cerebrospinal fluid shunts. Pediatr Neurosurg 17：10-13, 1991-1992

33）Kleinman G, et al：Malfunction of ventriculoperitoneal shunts during pregnancy. Obstet Gynecol 61：753-754, 1983

34）Razmara A, Jackson EM：Clinical indicators of pediatric shunt malfunction：a population-based study from the Nationwide Emergency Department Sample. Pediatr Emerg Care 37：e764-e766, 2021

35）Kim TY, et al：Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care 22：28-34, 2006

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

37）Livingston JH, et al：Bradycardia without associated hypertension：a common sign of ventriculo-peritoneal shunt malfunction. Childs Nerv Syst 27：729-733, 2011

38）Riva-Cambrin J, et al；Hydrocephalus Clinical Research Network：Risk factors for shunt malfunction in pediatric hydrocephalus：a multicenter prospective cohort study. J Neurosurg Pediatr 17：382-390, 2016

39）Browd SR, et al：Failure of cerebrospinal fluid shunts：part Ⅰ：obstruction and mechanical failure. Pediatr Neurol 34：83-92, 2006

40）de Oliveira RS, et al：An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children. Childs Nerv Syst 23：85-90, 2007

41）Bani A, Hassler WE：Laparoscopy-guided insertion of peritoneal catheters in ventriculoperitoneal shunt procedures：analysis of 39 children. Pediatr Neurosurg 42：156-158, 2006

42）Ratliff M, et al：Ventriculo-bipleural shunt as last resort in a 4-year-old child in whom a VP and VA shunt failed. J Neurosurg Pediatr 17：285-288, 2016

43）Girotti ME, et al：The ventriculo-gallbladder shunt in the treatment of refractory hydrocephalus：a review of the current literature. Am Surg 75：734-737, 2009

44）Pillai A, et al：Ventriculo-ureteral shunt insertion using percutaneous nephrostomy：a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures. J Neurosurg 127：255-259, 2017

45）Abuzayed B, et al：Ventriculo-femoro-caval shunt：a salvage surgery. Childs Nerv Syst 37：2413-2415, 2021

46）Nishiyama K, et al：Changes in cerebrospinal fluid hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicating hydrocephalus. J Neurosurg 98：1027-1031, 2003

47）Iannelli A, et al：CSF shunt removal in children with hydrocephalus. Acta Neurochir（Wien）147：503-507；discussion 507, 2005

48）Hader WJ, et al：Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery 63（1 Suppl 1）：ONS168-ONS174；discussion ONS174-ONS175, 2008

49）O'Brien DF, et al：Endoscopic third ventriculostomy：an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. J Neurosurg 103（5 Suppl）：393-400, 2005

50）Spennato P, et al：Third ventriculostomy in shunt malfunction. World Neurosurg 79（2 Suppl）：S22.e21-e26, 2013

51）Kita D, et al：Simultaneous ventriculoperitoneal shunt removal and endoscopic third ventriculostomy for three patients previously treated for intracranial germ cell tumors more than 20 years ago. Childs Nerv Syst 32：1543-1547, 2016

52）Durnford AJ, et al：Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus：validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 8：489-493, 2011

53）Kulkarni AV, et al：Cerebrospinal fluid shunt infection：a prospective study of risk factors. J Neurosurg 94：195-201, 2001

54）Choux M, et al：Shunt implantation：reducing the incidence of shunt infection. J Neurosurg 77：875-880, 1992

55）Hayashi T, et al：Efficacy of intraoperative irrigation with saline for preventing shunt infection. J Neurosurg Pediatr 6：273-276, 2010

56）Kestle JR, et al；Hydrocephalus Clinical Research Network：A standardized protocol to reduce cerebrospinal fluid shunt infection：the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8：22-29, 2011

57）6章 水頭症 9 脳室腹腔シャント術．山崎麻美，坂本博昭（編）：小児脳神経外科学改訂2版．金芳堂，東京，2015，pp. 464-493

58）Sarmey N, et al：Evidence-based interventions to reduce shunt infections：a systematic review. Childs Nerv Syst 31：541-549, 2015

59）Tamber MS, et al；Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force：Pediatric hydrocephalus：systematic literature review and evidence-based guidelines. Part 8：Management of cerebrospinal fluid shunt infection. J Neurosurg Pediatr 14（Suppl 1）：60-71, 2014

60）Simon TD, et al：Reinfection after treatment of first cerebrospinal fluid shunt infection：a prospective observational cohort study. J Neurosurg Pediatr 21：346-358, 2018

61）Gaderer C, et al：Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children. Childs Nerv Syst 34：1893-1903, 2018

62）Al Menabbawy A, et al：Outcome improvement in cerebral ventriculitis after ventricular irrigation：a prospective controlled study. J Neurosurg Pediatr 26：682-690, 2020

63）Park YS, et al：Efficacy and safety of intraventricular fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in extreme low birth weight infants：a preliminary clinical study. Childs Nerv Syst 37：69-79, 2021