The Relevant Clinical Analysis Of Diagnosis And Treatment Of Hydrocephalus

Hydrocephalus is one of the common diseases in nurosurgery. Its prevalence isnear1–1.5%among general population and is progressively rising with populationgrowth. Along with the development of CT and MRI, we acquire more in-depthunderstanding of the cause, the evolution and treatment of hydrocephalus.Hydrocephalus influences brain function and causes progressive brain damage, whichis not only a primary disease, but also one of the secondary disease of the centralnervous system diseases. Making the treatment more reasonable and more perfect isthe pursuit of neurosurgeons for years.274hydrocephalus patients of the FirstAffiliated Hospital of Fujian Medical University from June2007to June2011wereanalyzed retrospectively in order to improve the diagnosis, treatment and prognosis.Part I: The analysis of the etiology of hydrocephalus in different age groupObjective: To explore the relative etiology characteristics of hydrocephalus indifferent age group.Methods:274in-patient from June2007to June2011were analyzedretrospectively. According to the demarcation point of1year,4years,15years,45years and60years, all the cases were distinguished into6groups to analysisetiological formation.Results: There are37cases in <1year group,46%was congenital hydrocephalus,16%was associated with trauma,13.5%was infection,13.5%was aqueduct stenosisand11%was hemorrhage.19cases were in1-3years group,37%was associated withtumors,21%was trauma,21%was congenital hydrocephalus，16%was infection and5%was hemorrhage.48cases were in4-14years group,77%was associated withtumors,6.3%was hemorrhage，6.3%was congenital hydrocephalus,6.3%was traumaand4.1%was infection.84cases were in15-44years group,37%was associatedwith tumors,26%was trauma,15%was others causes,8%was aqueduct stenosis,5%was congenital hydrocephalus，5%was hemorrhage and4%was infection.45caseswere in45-59years group,40%was associated with hemorrhage,27%was trauma,20%was tumors,9%was others causes and4%was infection.41cases were in>60years group,39%was associated with trauma,27%was hemorrhage,15%was otherscauses,12%was tumors,5%was aqueduct stenosis and2%was infection.Conclusion: The etiological distribution of hydrocephalus in different age group was relative difference.Part II: The diagnosis and treatment of congenital hydrocephalus in childrenObjective: To summarize the experience of diagnosis and treatment incongenital hydrocephalus.Methods:29congenital hydrocephalus patients of the First Affiliated Hospitalof Fujian Medical University from June2007to June2011were analyzedretrospectively.Results: In all cases, there are27cases associated with Nervous systemmalformation, including6cases of callosal agenesis，5cases of aqueduct stenosis，3cases of meningocele，3cases of meningocele，2cases of Dandy-WalkerMalformation，1case of chiari1malformation，1case of heterotopic gray matter withschizencephaly，1case of cerebral dysgenesis，1case of schizencephaly，1case ofneurofibromatosis type1，1case of fourth ventricle cysts，1case of arachnoid cyst incerebello-medullary cistern and1case of septum pellucidum cysts.4cases associatedwith Other organs malformations were contained, including1case of hemivertebraldeformity at T7and right talipes equinovarus，1case of Chyle leakage,1case ofindirect inguinal hernia and1case of umbilical hernia.26cases were performedventriculoperitioneal shunt, and3cases underwent cyst-peritoneal shunt surgery.Adjustable valve shunts were used in the two therapies. Among the total,26caseshave good prognosis after surgery, and the other3cases have poor outcome.13caseshave postoperative complications.Conclusion: Congenital hydrocephalus in children often merged with otherorgans malformations. It’s important to pay attention to the relevant examination andmake clear diagnosis, which is beneficial for performing the specific therapy andimproving the prognosis.Part III: Strategy for therapy of acquired hydrocephalus in childrenObjective: To explore the diagnosis and treatment of acquired hydrocephalusin children.Methods:75children in-patient (age≤14years) from June2007to June2011with acquired hydrocephalus were analyzed retrospectively.Results: There are75patients with acquired hydrocephalus, including44casesassociated with tumors,13cases trauma,10cases infection and8cases intraventricular hemorrhage.32cases didn’t carry out further surgical interventionsuch as ventriculoperitioneal shunt when the primary disease was treated, amongthese cases, the hydrocephalus was associated with tumors in18cases,intraventricular hemorrhage in6cases, trauma in5cases and infection in3cases. Theother43cases underwent ventriculoperitioneal shunt after or before the treatment ofthe primary disease.Conclusion: Acquired hydrocephalus in children have relatively unique clinicaloutcomes because of the differences of primary disease and the specificity of pediatricanatomy and physiology, individual treatment should be performed according todifferences of primary disease and age.Part IV: Diagnosis and treatment of complex hydrocephalusobjective: To explore the diagnosis and treatment of complex hydrocephalus.Methods:20complex hydrocephalus patients of the First Affiliated Hospitalof Fujian Medical University from June2007to June2010were analyzedretrospectively.Results: Classified by the different accumulation area of cerebrospinal fluid,there were16cases which the cerebrospinal fluid couldn’t communicate with eachother between the bilateral ventricles,2cases with multiloculated hydrocephalus inone lateral ventricle, and the another2cases with uniloculated hydrocephalus inmultiple ventricles.3cases were confirmed as hydrocephalus at the initial diagnosis,and the other17cases were confirmed at the second diagnosis. According to thedifferent causes,17cases were acquired hydrocephalus, the other3case werecongenital hydrocephalus. Acquired hydrocephalus includes9cases hydrocephalusassociated with infection,3cases hydrocephalus associated with intraventricularhemorrhage,1case hydrocephalus associated with intraventricular hemorrhagecomplicated with infection,1case associated with tumors,1case associated withtrauma,1case associated with intracerebroventricular epidermoid cyst and1caseassociated with huge septum pellucidum cyst. All the cases performed the multipleshunt systems successively according to the accumulation area,17cases placed2shunt systems and the other3cases placed2shunt systems. Among the total,17caseshave good prognosis after surgery, and the other3cases have poor outcome.Conclusion: Infection and intraventricular hemorrhage are the most commoninducement of complex hydrocephalus. Making definite diagnosis at the first time is difficult, it is necessary to enhance the knowledge of complex hydrocephalus.However, individual choice of surgical treatment based on the differences of primarydiseases could bring optimal prognosis.