| Objectives: Diagnose external hydrocephalus by CT or MRI , then B ultrasound was used to observe the succession and the feature of imageology of external hydrocephalus, we probed diagnostic criteria in B ultrasound, the relation between the treatment and prognostic of external hydrocephalus combining clinical manifestation and the index of growth and development.Methods: All experimental objects weres 78 examples( 41boys, 37girls ) diagnosed external hydrocephalus in paediatric out-patient and inpatient department of the Second Hospital of Hebei Medical University from March in 2006 to Octomber in 2007, including 15 HIE, 6 intracranial hemorrhage, 5 hyperbilirubinemia, 10 intracranial infeion,4 febrile convulsion, 3 epilepsy, 7 angor nocturnes, 8 head circumferenceaugmentation, 14 anterior fontanel, 4 respiratory infection, 2 without any symptom. All experimental objects were divided into six groups every three months. Firstly we can diagnose external hydrocephalus by CT or MRI, Secondly B ultrasound was used to observe the architecture of brain from the coronal section and sagittal section. The brain middle was excentric or not. firstly, we could observe the architecture of brain and the appearance and seize of cerebral ventricle according to routine cross sections, Then the depth of cavitas subarachnoidealis and the width of fissura interhemisphaerica could be measured. Finally we measured the height, the weight, head circumference and evaluate the intelligence by Gesell developmental scale. Recheck every three months. The data was analyzed with SPSS for Windows 13.0 statistic software expressed as mean±standard deviation (mean±SD).Results: typical examples of cerebral CT and MRI in external hydrocephalus:(1)subarachnoid cavities in frontal and frontoparietal parts symmetrically broadened, not in posterior part;(2)frontal interhemispheric cistern widened, not in posterior part;(3)Sylvian fissure cisterns also widened.(4)suprasellar cistern slightly enlarged.(5)cortical sulci in frontal and frontoparietal parts widened and deepened, like petaloid ambulacra in the rim, other cisterns didn't change.(6)cerebral ventricle didn't enlarge or slightly enlarge,We can gain the results by B ultrasound: 78 examples(100%) subarachnoid cavities in frontal and frontoparietal parts broadened, the average was 4.73mm.64 examples ( 85% ) frontal interhemispheric cistern widened, the average was 5.54mm. 43 examples(55%)sylvian fissure cisterns widened, 5 examples(6%)basal cistern enlarged, 7 examples (9%) cerebral ventricle slightly enlarged. From age groups, subarachnoid cavities and frontal interhemispheric cistern didn't widened in neonatal period. Comparing with subarachnoid cavities frontal interhemispheric cistern widened extreme obviously from first month to third month. subarachnoid cavities in frontal or frontoparietal parts and frontal interhemispheric cistern widened largest from third month to sixth month, inclulding 4 examples sylvian fissure cisterns widened and suprasellar cistern slightly enlarged, inclulding 2 examples subdural collection of fluid and cerebral atrophy 1 examples, which reflected obviously in HIE, intracranial hemorrhage. subarachnoid cavities in frontal or frontoparietal parts and frontal interhemispheric cistern gradually diminished after 6 months, 54examples had vanished till anterior fontanelle closed, cerebral atrophy hadn't changed obviously. So we thought that the width of fissure interhemisphaerica and the depth of cavitas subarachnoidealis could be took as the index estimating external hydrocephalus. The sonogram of external hydrocephalus infants was the depth of cavitas subarachnoidealis(4.17±1.09mm)and the width of fissure interhemisphaerica(4.92±0.84mm).The result of intelligence evaluation: sixth months: there were 47 examples whose score exceed 85, including 8 intracranial infeion, 3 febrile convulsion, 1 epilepsy, 7 angor nocturnes, 8 head circumferenceaugmentation, 14 anterior fontanel, 4 respiratory infection, 2 without any symptom. there were 20 examples, whose score varied from 75 to 84, including 11 HIE, 1 intracranial hemorrhage, 4 hyperbilirubinemia, 1 intracranial infeion, 1 febrile convulsion, 1 epilepsy, coarse action, fine action, individual-society, language and adaptive behavior had been fell behind in 11 examples, motor development fell behind over 1.8 months, the level of coarse action and fine action were identical, the average score were 78 and 76. There were 7 examples whose language ablity fell behind and the score were 81. there were 11 examples whose score below 74, coarse action, fine action, individual-society, language and adaptive behavior had been fell behind. Twelfth months: there were 45 examples whose score exceed 85, including 7 intracranial infeion, 2 febrile convulsion, 1 epilepsy, 7 angor nocturnes, 8 head circumferenceaugmentation, 14 anterior fontanel, 4 respiratory infection, 2 without any symptom. there were 18 examples, whose score varied from 75 to 84, including 9 HIE , 1 intracranial hemorrhage, 4 hyperbilirubinemia, 1 intracranial infeion, 1 febrile convulsion, 1 epilepsy, coarse action, fine action, individual-society, language and adaptive behavior had been fell behind in 10 examples, motor development fell behind over 2 months, the level of coarse action and fine action were identical, the average score were 76 and 75. There were 7 examples whose language ablity fell behind and the score were 81. there were 15 examples whose score was below 74, coarse action, fine action, individual-society, language and adaptive behavior had been fell behind, including 7 HIE, 5 intracranial hemorrhage, 2 hyperbilirubinemia, 1 intracranial infeion.The result of head circumference: the average head circumference of new-born infant was 35.4 cm, Among postnatal three months, the average of head circumference was 42.3 cm, there was 44.5cm, 46.4cm, 47.6cm, 48.7cm in the sixth, nineth, twelfth, eighteenth month, which was almost equal between the objects and the normal children.The result of body length and body weight: not only body length and body weight of new-born infant but also velocity of increase, both the objects and the normal children hadn't significant difference.Conclusions: 1 As a special sort of communicating hydrocephalus, external hydrocephalus which existed normal infant with growth and development, shouldn't regard as sick and eusemia. but effective therapeutic measures should be taken positively with regurd to acquired external hydrocephalus.2 B ultrasound which had some merits such as sensitiveness, reliability, no radiation,low expense, reproducibility,had used to observe external hydrocephalus dynamic.3 The width of fissure interhemisphaerica and the depth of cavitas subarachnoidealis could be taken as the index estimating external hydrocephalus.The sonogramof external hydrocephalus infants was the depth of cavitas subarachnoidealis(4.17±1.09mm)and the width of fissure interhemisphaerica (4.92±0.84mm). |
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