CT脑池造影在脑积水的诊断及治疗中的应用研究
发布时间：2018-08-29 16:26
【摘要】：研究背景和目的 脑积水是神经外科医生面临的最常见和棘手的临床疾病之一,其发病机制复杂,其根本治疗在于外科手术,药物治疗多为临时措施。影像学多表现脑室脑池扩张,或单纯侧脑室扩张,原因有原发性的中脑导水管梗阻、囊肿或肿瘤压迫,或颅内出血后引起蛛网膜颗粒吸收不良或吸收障碍。部分患者无明显临床症状,体检或外伤检查发现,大多数患者出现临床症状后发现,其发生机制以及分类等目前仍存争议大,争议主要有两点：一是梗阻性脑积水与交通性脑积水的判断标准,二是神经内镜对脑积水治疗的适应症。目前诊断脑积水的方式除了结合临床症状以外主要依靠CT和MR影像学检查。CT和MRI检查方便,损伤较小,所以在脑积水的诊断和随访中有重要价值。但是脑积水病理机制复杂,有些时候很难发现阻塞性病变,无法明确诊断,对手术的选择比较困难。有文献报道磁共振弥散加权成像(diffusion。weighted imaging, DWI)及相位对比电影法能明确鉴别,但本研究预实验证实其准确率低,可行性需要进一步研究。因此,我们提出CT脑池造影检查(CT cistemography, CTC),并证实CTC是明确鉴别交通性与非交通性脑积水的有效方法。且对脑积水的治疗能起到一定的指导作用。CT脑池显像是将无刺激性的,不参与代谢的水溶性非离子碘剂经腰椎穿刺术注入蛛网膜下腔,然后非离子碘剂沿着脑脊液循环途径逆行上行,依次进入各个脑池脑室,最后到达大脑凸面上矢状窦吸收入血液,用CT螺旋扫描可显示蛛网膜下腔的通畅情况,经三维重建可见各脑室脑池之间造影剂的成像,以及脑脊液循环通路的动力学是否发生改变,明确梗阻部位。神经内镜使用之前,分流术一直是脑积水外科治疗的首先方法,但分流术术后后存在的问题是并发症较多多,容易发生分流管堵塞、感染、分流过度或者不足等,最终导致手术失败。McGirt报告308例脑积水的分流术因手术失败行分流管调整术528次。分流术后病人体内将终身留置异物,低龄病人随身材长高还可能须多次换管,因此如何避免行分流术一直是神经外科医师关注的重要问题。随着神经内镜的发展,神经内镜下治疗梗阻性脑积水已成首选术式,具有手术打击小,术后恢复快,并发症少,住院周期短等诸多优点,对梗阻性脑积水的远期疗效达90%以上。国内外有报道神经内镜治疗分流术后脑室腹腔分流管堵塞导致分流失败的脑积水病例,预后效果可。 本研究对48例病例行进行CTC检查并进行了前瞻性研究,探讨CTC在脑积水疾病的诊断及治疗中的运用价值。脑积水的治疗原则一直都是国内外争论的主题。争议的焦点在于手术指征把握及手术方式的选择,即哪种类型的脑积水需要手术治疗,哪种手术方式最佳,众多文献报道不一,通过CTC检查明确脑积水类型,选择正确的手术方式及减少病人痛苦是本文的研究重点。 方法 1、CT脑池造影在脑积水诊断中的应用 通过分析总结我院神经外科2011年2月-2012年12月48例脑积水患者进行CT脑池造影,根据造影结果诊断脑积水的类型和选择治疗方式。分析CTC检查与常规CT/MRI的诊断准确率。分析造影过程中颅内压对造影剂扩散的影响。 2、CT脑池造影在脑积水神经内镜三脑室底造瘘术后的应用 24例梗阻性脑积水患者行三脑室底造瘘术后,随机抽取8例患者术后一周进行CTC复查,根据造影剂的扩散情况分析三脑室底造瘘术后脑脊液通路改善情况；通过术前术后腰穿压力比较,分析三脑室底造瘘的效果。术后进行常规的CT或MRI影像资料随访。 2、统计学处理 所有结果均应用SPSS13.0软件进行统计学分析,采用T检验、方差分析和卡方检验。P≤0.05视为有统计学意义。 结果 1、CT脑室脑池造影在脑积水诊断中的应用 1.1、影像检查结果本组48例患者术前均行头颅CT检查,40例行头颅MR检查,本组48例均行CT脑池造影,其中22例脑室脑池造影剂均显影,脑室脑池及蛛网膜下腔造影剂填充,证实交通性脑积水；其中26例造影剂扩散的通路上出现不同程度的梗阻现象,诊断为非交通性脑积水。 (1)交通性脑积水：脑池显像双侧侧脑室显影并持续滞留即诊断为交通性脑积水,影像冠状位可以看到造影剂扩散至侧脑室与三脑室、四脑室,影像矢状位可以看到造影剂扩散从枕大池-四脑室-经中脑导水管到达三脑室-双侧侧脑室,基底池及幕上蛛网膜下腔均充盈良好。 (2)非交通性脑积水：大多为部位梗阻性脑积水,脑池影像无固定的特征,因梗阻部位不同可有不同表现,侧脑室一般不显影,部分梗阻性脑积水的患者造影剂长时间滞留于枕大池和基底池,CT扫描时冠状位无“Y”型影像。 1.2、CTC与常规CT/MRI诊断结果的比较。 本组病例CT脑池影像结果提示26例为非交通性脑积水,其中有15例在常规CT/MRI诊断为梗阻性脑积水的患者,符合CTC诊断结果。其中CTC检查中有2例因倒位原因造影剂扩散不佳,交通性脑积水误诊为梗阻性脑积水,诊断准确率95.8%；常规CT/MRI检查中有2例交通性诊断为梗阻性,5例梗阻性诊断为交通性,诊断准确率为85.4%。 1.3、颅内压对造影剂扩散的影响 从腰椎穿刺注入造影剂,进行逆向扩散CT显影,为了探讨颅内压对造影剂扩散的影响,对41例行脑室脑池造影的病例进行回顾性分析,41例病例中的脑室脑池内均充盈造影剂。并且采用同样的造影方式和造影剂扩散时间。根据腰穿压力分成两组,一组腰椎穿刺压力≥200mmH2O,另一组腰椎穿刺测压压力在正常范围,即200mmH2O,通过两组造影剂在脑室脑池的显影情况CT值(Hu)进行比较。结果显示两组造影剂扩散的效果无明显的统计学差异,P0.05。 2、CTC在脑积水神经内镜三脑室底造瘘术中的应用 (1)24例患者术后6个月复查MRI,其中14例患者脑室脑池明显缩小,术前头痛头晕症状消失,其中3例术前意识障碍患者,术后意识障碍明显改善；5例脑室脑池稍缩小,临床症状明显改善；6例患者影像学无明显变化,其中4例临床症状明显改善,1例因脑积水吸收障碍再次行脑室腹腔分流术后改善。 (2)24例患者术后3天行腰椎穿刺检查,排除行腰穿术前静脉使用甘露醇注射液。其中13例腰穿压力70～100mmH2O,6例腰穿压力110～150mmH2O,3例为160～180mmH2O,2例≥180mmH2O。术前术后腰穿压力比较结果显示P0.05,提示有统计学意义,造瘘术后压力改善。 (3)术后一周随机抽取8例进行CTC复查,结果显示8例病例脑室均充盈造影剂。3例术前四脑室扩张明显患者,术后四脑室明显缩小,术后1个月复查MRI,脑室脑池基本正常。 结论 1、CT脑池造影在脑积水的诊断中,尤其是对梗阻性脑积水与交通性脑积水的鉴别诊断中的作用尤为重要,且CTC检查为脑积水是否手术治疗以及选择手术方式提供可靠的依据,CTC较常规CT/MRI的诊断准确率高。 2、合理剂量下进行CT脑室脑池造影检查是安全的有效的, CT脑池造影虽为有创性检查方法,但它是一种简便、安全、可靠、快速的能明确诊断脑积水的有效方法。 3、经腰椎穿刺途径进行CT脑室脑池造影时,颅内压的大小并不影响造影剂扩散的效果。从结论看进行CT脑室脑池时可以不考虑颅内压的大小来增加或减少造影剂剂量,进一步提高造影的安全性和有效性。 4、术后CTC检查可初步评价脑积水的手术效果。对于CT和MR无法明确诊断的患者行CTC检查是有必要的,证实为梗阻性脑积水的患者且达到手术指征应考虑神经内镜造瘘手术治疗,根据术后CTC复查结果以及临床症状的改善程度可以综合评估手术效果。 5、神经内镜手术损伤小、手术时间短、可直视、成像清晰、视角宽阔、恢复快、并发症少、远期疗效佳,相对之前单纯的脑室腹腔分流术,神经内镜的出现无疑减少了患者的长期带管的痛苦和不便,神经内镜造瘘手术是梗阻性脑积水的有效的治疗方法。 本研究创新之处 1、CT脑池造影是脑积水的诊断的可靠标准,尤其是对难以鉴别梗阻性与交通性脑积水的诊断,并且为指导治疗及初步疗效提供依据。提出了CTC检查的指征。 2、通过CTC检查,对脑积水的分类有了安全、可靠的诊断方法。 3、CTC是评估神经内镜三脑室底造瘘术术后的效果的可靠指标。
[Abstract]:Research background and purpose
Hydrocephalus is one of the most common and intractable clinical diseases facing neurosurgeons. Its pathogenesis is complex. Its fundamental treatment is surgery. Medication is mostly temporary. Imaging manifestations include ventricular cistern dilatation, or simple lateral ventricle dilatation. The causes include primary mesencephalic aqueduct obstruction, cyst or tumor compression, or cranium. Some patients have no obvious clinical symptoms. Physical examination or trauma examination found that most patients have clinical symptoms. The mechanism and classification of the occurrence of arachnoid granules are still controversial. There are two main controversies: one is the criteria of obstructive hydrocephalus and communicating hydrocephalus. At present, the diagnosis of hydrocephalus mainly relies on CT and MR imaging besides clinical symptoms. CT and MRI are convenient and less invasive, so they have important value in the diagnosis and follow-up of hydrocephalus. It is reported that diffusion. weighted imaging (DWI) and phase contrast cine can clearly differentiate the obstructive lesions, but this preliminary study confirms that the accuracy is low and the feasibility needs further study. CT cistern imaging injects non-irritating, non-metabolic water-soluble nonionic iodine into the subarachnoid space through lumbar puncture, and then nonionic iodine is injected along the cerebrospinal spine. The fluid circulatory pathway ascends retrogradely and enters the ventricles of each cistern in turn, then reaches the sagittal sinus on the convex surface of the brain to absorb blood. CT spiral scanning can show the patency of the subarachnoid space. The imaging of contrast agents between the cisterns of each ventricle can be seen by three-dimensional reconstruction, and whether the dynamics of the cerebrospinal fluid circulatory pathway has changed to determine the obstruction. Location. Before neuroendoscopy, shunting was always the first method of surgical treatment for hydrocephalus, but the problems after shunting were more complications, prone to blockage of shunt, infection, excessive or insufficient shunting, which eventually led to failure of surgery. McGirt reported 308 cases of hydrocephalus who underwent shunting because of surgical failure. Adjustments were performed 528 times. Foreign bodies were retained in patients after shunting, and the long and tall personal belongings of younger patients may need to be replaced many times. Therefore, how to avoid shunting has always been an important issue for neurosurgeons. With the development of neuroendoscopy, endoscopic treatment of obstructive hydrocephalus has become the preferred operation with surgical strikes. The long-term effect of endoscopic neurosurgery on obstructive hydrocephalus is more than 90%. It has been reported that endoscopic neurosurgery for hydrocephalus caused by ventriculoperitoneal shunt obstruction after shunt surgery has a good prognosis.
In this study, 48 cases of hydrocephalus were examined by CTC and prospectively studied to explore the value of CTC in the diagnosis and treatment of hydrocephalus. There are many different reports about which operation method is the best for the treatment of hydrocephalus. The focus of this paper is to ascertain the type of hydrocephalus by CTC, choose the correct operation method and reduce the pain of patients.
Method
1, CT cisterography in the diagnosis of hydrocephalus
CT cisternography was performed in 48 patients with hydrocephalus from February 2011 to December 2012 in neurosurgery department of our hospital. The types of hydrocephalus were diagnosed and the treatment methods were selected according to the results of CT cisternography.
2, CT cisterography in hydrocephalus after endoscopic three ventriculostomy.
Twenty-four patients with obstructive hydrocephalus underwent three-ventricular floor fistula. Eight patients were randomly selected for a one-week follow-up of CTC. The improvement of cerebrospinal fluid pathway after three-ventricular floor fistula was analyzed according to the diffusion of contrast media. Follow up of imaging data.
2, statistical processing
All the results were analyzed by SPSS13.0 software. T test, variance analysis and chi-square test were used. P < 0.05 was regarded as statistically significant.
Result
1. The application of CT ventriculography in the diagnosis of hydrocephalus.
1.1. Imaging findings: All 48 patients underwent cranial CT examination before operation, 40 patients underwent cranial MR examination, 48 patients underwent CT cisternography, of which 22 patients underwent ventricular cisternography, ventricular cisternography and subarachnoid cavity contrast medium filling, which confirmed communicating hydrocephalus; 26 patients had different degrees of infarction in the diffusion pathway of contrast medium. Obstruction is diagnosed as non communicating hydrocephalus.
(1) communicating hydrocephalus: bilateral ventricles of cistern imaging with persistent detention were diagnosed as communicating hydrocephalus. Contrast agent diffused to lateral ventricle and third ventricle, fourth ventricle and fourth ventricle were seen in coronal image. Contrast agent diffused from occipital cistern to fourth ventricle to third ventricle and bilateral ventricle through midbrain aqueduct. The cistern and supratentorial subarachnoid space were well filled.
(2) Non-communicating hydrocephalus: most of them are obstructive hydrocephalus. The images of cistern have no fixed features, and there are different manifestations because of different obstructive sites. The lateral ventricle is not usually developed. Contrast media of some patients with obstructive hydrocephalus remain in the occipital cistern and basal cistern for a long time.
1.2, the comparison between CTC and routine CT/MRI diagnosis.
The results of CT cistern imaging showed that 26 cases were non-communicating hydrocephalus, of which 15 cases were diagnosed as obstructive hydrocephalus by routine CT/MRI, which accorded with the results of CTC. In the examination, 2 cases were diagnosed as obstructive by traffic diagnosis, 5 cases were diagnosed as communicating by obstruction, and the diagnostic accuracy was 85.4%.
1.3, the effect of intracranial pressure on the diffusion of contrast agents.
In order to investigate the effect of intracranial pressure on the diffusion of contrast media, 41 cases of ventriculo-cisternography were retrospectively analyzed. The ventriculo-cisternography in 41 cases was filled with contrast media, and the same contrast mode and diffusion time were used. Two groups, one group of lumbar puncture pressure (> 200 mm H2O) and the other group of lumbar puncture pressure in the normal range, that is, 200 mm H2O, were compared by two groups of contrast media in the ventricular cistern CT value (Hu).
2. Application of CTC in hydrocephalus endoscopic three Ventriculostomy
(1) MRI was performed in 24 patients 6 months after operation. The ventricular cistern was significantly reduced in 14 of them, and the symptoms of headache and dizziness disappeared before operation. Among them, 3 patients with preoperative disturbance of consciousness were significantly improved after operation; 5 patients with slight reduction of ventricular cistern and obvious improvement of clinical symptoms; 6 patients with no significant changes in imaging, 4 of them were significantly improved in clinical symptoms. 1 cases were improved after ventriculoperitoneal shunt for hydrocephalus.
(2) 24 patients were examined by lumbar puncture 3 days after operation, and mannitol injection was used intravenously before lumbar puncture excluding lumbar puncture. Among them, 13 cases had lumbar puncture pressure of 70-100 mm H2O, 6 cases had lumbar puncture pressure of 110-150 mm H2O, 3 cases had lumbar puncture pressure of 160-180 mm H2O, and 2 cases had lumbar puncture pressure of more than 180 mm H2O. Good.
(3) Eight cases were randomly selected one week after operation for CTC reexamination. The results showed that the ventricles of 8 cases were filled with contrast media. Three cases had evident dilatation of the fourth ventricle before operation, and the fourth ventricle was significantly reduced after operation.
conclusion
1. CT cisternography plays an important role in the diagnosis of hydrocephalus, especially in the differential diagnosis between obstructive hydrocephalus and communicating hydrocephalus. CTC provides a reliable basis for the surgical treatment of hydrocephalus and the choice of surgical methods. CTC has a higher diagnostic accuracy than conventional CT/MRI.
2. It is safe and effective to perform CT cisternography at a reasonable dose. Although CT cisternography is a invasive method, it is a simple, safe, reliable and rapid method for definite diagnosis of hydrocephalus.
3. Intracranial pressure does not affect the effect of contrast media diffusion in CT ventriculo cisternography via lumbar puncture. ConclusionIntracranial pressure can be neglected to increase or decrease the dose of contrast media in CT ventriculo cisternography to further improve the safety and effectiveness of contrast media.
4. Postoperative CTC can evaluate the effect of hydrocephalus. It is necessary for patients with obstructive hydrocephalus who can not be diagnosed clearly by CT and MR to have CTC. Neuroscopic fistula should be considered when the operation indication is reached. Evaluate the effect of operation.
5. Neuroendoscopic surgery has the advantages of small injury, short operation time, direct vision, clear imaging, wide visual angle, quick recovery, fewer complications, and good long-term effect. Compared with the previous simple ventriculoperitoneal shunt, the emergence of neuroendoscopy undoubtedly reduces the patient's long-term pain and inconvenience with the tube. Neuroendoscopic fistula surgery is effective for obstructive hydrocephalus. Treatment.
The innovation of this research
1. CT cisternography is a reliable criterion for the diagnosis of hydrocephalus, especially for the diagnosis of obstructive and communicating hydrocephalus which is difficult to differentiate, and provides a basis for guiding treatment and preliminary curative effect.
2, through CTC examination, there is a safe and reliable diagnostic method for hydrocephalus classification.
3, CTC is a reliable index to evaluate the effect of endoscopic three ventriculostomy.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.1;R742.7
本文编号：2211758
[Abstract]:Research background and purpose
Hydrocephalus is one of the most common and intractable clinical diseases facing neurosurgeons. Its pathogenesis is complex. Its fundamental treatment is surgery. Medication is mostly temporary. Imaging manifestations include ventricular cistern dilatation, or simple lateral ventricle dilatation. The causes include primary mesencephalic aqueduct obstruction, cyst or tumor compression, or cranium. Some patients have no obvious clinical symptoms. Physical examination or trauma examination found that most patients have clinical symptoms. The mechanism and classification of the occurrence of arachnoid granules are still controversial. There are two main controversies: one is the criteria of obstructive hydrocephalus and communicating hydrocephalus. At present, the diagnosis of hydrocephalus mainly relies on CT and MR imaging besides clinical symptoms. CT and MRI are convenient and less invasive, so they have important value in the diagnosis and follow-up of hydrocephalus. It is reported that diffusion. weighted imaging (DWI) and phase contrast cine can clearly differentiate the obstructive lesions, but this preliminary study confirms that the accuracy is low and the feasibility needs further study. CT cistern imaging injects non-irritating, non-metabolic water-soluble nonionic iodine into the subarachnoid space through lumbar puncture, and then nonionic iodine is injected along the cerebrospinal spine. The fluid circulatory pathway ascends retrogradely and enters the ventricles of each cistern in turn, then reaches the sagittal sinus on the convex surface of the brain to absorb blood. CT spiral scanning can show the patency of the subarachnoid space. The imaging of contrast agents between the cisterns of each ventricle can be seen by three-dimensional reconstruction, and whether the dynamics of the cerebrospinal fluid circulatory pathway has changed to determine the obstruction. Location. Before neuroendoscopy, shunting was always the first method of surgical treatment for hydrocephalus, but the problems after shunting were more complications, prone to blockage of shunt, infection, excessive or insufficient shunting, which eventually led to failure of surgery. McGirt reported 308 cases of hydrocephalus who underwent shunting because of surgical failure. Adjustments were performed 528 times. Foreign bodies were retained in patients after shunting, and the long and tall personal belongings of younger patients may need to be replaced many times. Therefore, how to avoid shunting has always been an important issue for neurosurgeons. With the development of neuroendoscopy, endoscopic treatment of obstructive hydrocephalus has become the preferred operation with surgical strikes. The long-term effect of endoscopic neurosurgery on obstructive hydrocephalus is more than 90%. It has been reported that endoscopic neurosurgery for hydrocephalus caused by ventriculoperitoneal shunt obstruction after shunt surgery has a good prognosis.
In this study, 48 cases of hydrocephalus were examined by CTC and prospectively studied to explore the value of CTC in the diagnosis and treatment of hydrocephalus. There are many different reports about which operation method is the best for the treatment of hydrocephalus. The focus of this paper is to ascertain the type of hydrocephalus by CTC, choose the correct operation method and reduce the pain of patients.
Method
1, CT cisterography in the diagnosis of hydrocephalus
CT cisternography was performed in 48 patients with hydrocephalus from February 2011 to December 2012 in neurosurgery department of our hospital. The types of hydrocephalus were diagnosed and the treatment methods were selected according to the results of CT cisternography.
2, CT cisterography in hydrocephalus after endoscopic three ventriculostomy.
Twenty-four patients with obstructive hydrocephalus underwent three-ventricular floor fistula. Eight patients were randomly selected for a one-week follow-up of CTC. The improvement of cerebrospinal fluid pathway after three-ventricular floor fistula was analyzed according to the diffusion of contrast media. Follow up of imaging data.
2, statistical processing
All the results were analyzed by SPSS13.0 software. T test, variance analysis and chi-square test were used. P < 0.05 was regarded as statistically significant.
Result
1. The application of CT ventriculography in the diagnosis of hydrocephalus.
1.1. Imaging findings: All 48 patients underwent cranial CT examination before operation, 40 patients underwent cranial MR examination, 48 patients underwent CT cisternography, of which 22 patients underwent ventricular cisternography, ventricular cisternography and subarachnoid cavity contrast medium filling, which confirmed communicating hydrocephalus; 26 patients had different degrees of infarction in the diffusion pathway of contrast medium. Obstruction is diagnosed as non communicating hydrocephalus.
(1) communicating hydrocephalus: bilateral ventricles of cistern imaging with persistent detention were diagnosed as communicating hydrocephalus. Contrast agent diffused to lateral ventricle and third ventricle, fourth ventricle and fourth ventricle were seen in coronal image. Contrast agent diffused from occipital cistern to fourth ventricle to third ventricle and bilateral ventricle through midbrain aqueduct. The cistern and supratentorial subarachnoid space were well filled.
(2) Non-communicating hydrocephalus: most of them are obstructive hydrocephalus. The images of cistern have no fixed features, and there are different manifestations because of different obstructive sites. The lateral ventricle is not usually developed. Contrast media of some patients with obstructive hydrocephalus remain in the occipital cistern and basal cistern for a long time.
1.2, the comparison between CTC and routine CT/MRI diagnosis.
The results of CT cistern imaging showed that 26 cases were non-communicating hydrocephalus, of which 15 cases were diagnosed as obstructive hydrocephalus by routine CT/MRI, which accorded with the results of CTC. In the examination, 2 cases were diagnosed as obstructive by traffic diagnosis, 5 cases were diagnosed as communicating by obstruction, and the diagnostic accuracy was 85.4%.
1.3, the effect of intracranial pressure on the diffusion of contrast agents.
In order to investigate the effect of intracranial pressure on the diffusion of contrast media, 41 cases of ventriculo-cisternography were retrospectively analyzed. The ventriculo-cisternography in 41 cases was filled with contrast media, and the same contrast mode and diffusion time were used. Two groups, one group of lumbar puncture pressure (> 200 mm H2O) and the other group of lumbar puncture pressure in the normal range, that is, 200 mm H2O, were compared by two groups of contrast media in the ventricular cistern CT value (Hu).
2. Application of CTC in hydrocephalus endoscopic three Ventriculostomy
(1) MRI was performed in 24 patients 6 months after operation. The ventricular cistern was significantly reduced in 14 of them, and the symptoms of headache and dizziness disappeared before operation. Among them, 3 patients with preoperative disturbance of consciousness were significantly improved after operation; 5 patients with slight reduction of ventricular cistern and obvious improvement of clinical symptoms; 6 patients with no significant changes in imaging, 4 of them were significantly improved in clinical symptoms. 1 cases were improved after ventriculoperitoneal shunt for hydrocephalus.
(2) 24 patients were examined by lumbar puncture 3 days after operation, and mannitol injection was used intravenously before lumbar puncture excluding lumbar puncture. Among them, 13 cases had lumbar puncture pressure of 70-100 mm H2O, 6 cases had lumbar puncture pressure of 110-150 mm H2O, 3 cases had lumbar puncture pressure of 160-180 mm H2O, and 2 cases had lumbar puncture pressure of more than 180 mm H2O. Good.
(3) Eight cases were randomly selected one week after operation for CTC reexamination. The results showed that the ventricles of 8 cases were filled with contrast media. Three cases had evident dilatation of the fourth ventricle before operation, and the fourth ventricle was significantly reduced after operation.
conclusion
1. CT cisternography plays an important role in the diagnosis of hydrocephalus, especially in the differential diagnosis between obstructive hydrocephalus and communicating hydrocephalus. CTC provides a reliable basis for the surgical treatment of hydrocephalus and the choice of surgical methods. CTC has a higher diagnostic accuracy than conventional CT/MRI.
2. It is safe and effective to perform CT cisternography at a reasonable dose. Although CT cisternography is a invasive method, it is a simple, safe, reliable and rapid method for definite diagnosis of hydrocephalus.
3. Intracranial pressure does not affect the effect of contrast media diffusion in CT ventriculo cisternography via lumbar puncture. ConclusionIntracranial pressure can be neglected to increase or decrease the dose of contrast media in CT ventriculo cisternography to further improve the safety and effectiveness of contrast media.
4. Postoperative CTC can evaluate the effect of hydrocephalus. It is necessary for patients with obstructive hydrocephalus who can not be diagnosed clearly by CT and MR to have CTC. Neuroscopic fistula should be considered when the operation indication is reached. Evaluate the effect of operation.
5. Neuroendoscopic surgery has the advantages of small injury, short operation time, direct vision, clear imaging, wide visual angle, quick recovery, fewer complications, and good long-term effect. Compared with the previous simple ventriculoperitoneal shunt, the emergence of neuroendoscopy undoubtedly reduces the patient's long-term pain and inconvenience with the tube. Neuroendoscopic fistula surgery is effective for obstructive hydrocephalus. Treatment.
The innovation of this research
1. CT cisternography is a reliable criterion for the diagnosis of hydrocephalus, especially for the diagnosis of obstructive and communicating hydrocephalus which is difficult to differentiate, and provides a basis for guiding treatment and preliminary curative effect.
2, through CTC examination, there is a safe and reliable diagnostic method for hydrocephalus classification.
3, CTC is a reliable index to evaluate the effect of endoscopic three ventriculostomy.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.1;R742.7
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