脳障害と治療

概要

Experience with Lumber Puncture for Obstructive Hydrocephalus Patients following Endoscopic Surgery

Zhiqiang Hu*, Zhuang Kang, Guangtong Zhu, Jian Tu2, Hui Huang, Feng Guan, Bin Dai and Beibei Mao

Background: Following endoscopic third ventriculostomy (ETV), the intracranial pressure (ICP) of some patients remains high immediately. The cause of this phenomenon is still controversial. The objective of this study is to explore the effect of postoperative lumbar puncture following ETV for obstructive hydrocephalus patients.

Methods: 145 patients presenting with obstructive hydrocephalus underwent ETV in our department between 2009 and 2014. Following ETV, all patients received lumbar punctures 1 and 3 days after surgery.

Results: For 106 patients, intracranial pressure (ICP) returned to normal levels and symptoms associated with high ICP ceased. In 39 patients, intracranial pressure remained high and they continued to receive lumbar punctures every other day for a period of 11 days post-surgery. These patients were divided into two groups for analysis: group A (<18 years old) and group B (>18 years old). Intracranial pressure of both groups increased initially before decreasing to normal values. Peak values of ICP for groups A and B occurred on days 3 and 5, respectively.

Conclusions: Postoperative lumbar puncture is important to determine the effect of surgery or treatment on transient high ICP after ETV. For most of these symptomatic patients with obstructive hydrocephalus, lumbar punctures were effective in bringing about fast normalization of ICP and cessation of adverse symptoms.