| Objective:To investigate the clinical effect and complications of ventriculoperitoneal shunt in secondary hydrocephalus.Materials and methods:The clinical data of 61 patients with secondary hydrocephalus(non-obstructive)treated by neurosurgery in the first affiliated hospital of Nanchang University from November 2017 to September 2019 were retrospectively analyzed.According to the clinical symptoms and physical conditions of the patients,they were divided into two groups,conscious and conscious groups,and different preoperative evaluation methods were used respectively.All patients underwent cerebrospinal fluid discharge test and ventriculoperitoneal shunt.summarize the surgical effect and complications.Result:There were 38 cases(62.3%)of hydrocephalus after traumatic brain injury,9cases(14.8%)of hydrocephalus after hypertensive intracerebral hemorrhage,5 cases(8.2%)of hydrocephalus after cerebral aneurysm hemorrhage,3 cases(4.9%)of hydrocephalus after moyamoya disease hemorrhage,4 cases(6.6%)of hydrocephalus after cerebral infarction,and 2 cases(3.3%)of hydrocephalus after brain tumor operation.Preoperative evaluation results :1.Conscious group: preoperative evaluation positive 16 cases,negative 9 cases.Gait assessment was positive in 13 cases,cognitive assessment in 4 cases and urine assessment in 6 cases.The specificity of preoperative evaluation was 50.0% and the sensitivity was 66.7%.2.consciousness disorder group: preoperative evaluation of 22 positive,negative 14.The specificity of preoperative evaluation was 66.7% and the sensitivity was 70.4%.3.overall preoperative evaluation results: preoperative evaluation of 38 positive,23 negative,preoperative evaluation of the specificity of 61.5%,sensitivity of 68.8%.Shunt results :1.Conscious group :25 patients,significantly improved 9(36.0%),improved 12(48.0%),no change 3(12.0%),deteriorated 1(4.0%),the effective rate of shunt surgery was 84.0%.2.consciousness disorder group: a total of 36 patients,significantly improved 10 cases(27.8%),improved 17 cases(47.2%),no change 9cases(25.0%),deteriorated 0 cases(0.0%),the effective rate of shunt surgery was75.0%.3.total :61 patients,significantly improved 19(31.1%),improved There were29 cases(47.5%),12 cases(19.7%)without change case(1.6%),and the effective rate of shunt operation was 78.7%.At the same time,17 patients underwent craniotomy,7patients underwent staged surgery,and 8 patients underwent craniotomy.Recent postoperative complications :1.Conscious group :2(8.0%)complications,including 1(4.0%)puncture bleeding,2(8.0%)epilepsy.2.consciousness disorder group :5 cases(13.9%)of complications,including 2 cases of puncture bleeding(5.6%),1 case of non-infectious obstruction(2.8%),3 cases of shunt infection(8.3%).3.total patients :7 cases(11.5%)of complications,including 3 cases of puncture bleeding(4.9%),3 cases of shunt infection(4.9%),2 cases of epilepsy(3.3%),1 case of non-infectious obstruction(1.6%).Long-term postoperative complications :1.Conscious group :3 cases(12.0%)of complications,2 cases(8.0%)of non-infectious obstruction,1 case(4.0%)of epilepsy and 1 case(4.0%)of subdural hematoma.2.consciousness disorder group:complications 4(11.1%),including shunt infection 2(5.6%),subdural hematoma1(2.%),subdural effusion 1(2.%),epilepsy 2(5.6%).3.total :7 cases(11.5%)with shunt-related complications,2 cases(3%3.)with shunt infection and 2 cases with non-infectious obstruction cases(3.3%);subdural effusion 1(1.6%);epilepsy 3(4.9%);chronic subdural hematoma 2(3.3%).Conclusion:The effective rate of secondary hydrocephalus shunt was 78.7%,the short-term complication was 11.5%,and the long-term complication was 11.5%.Ventricularabdominal shunt is an effective and safe method for the treatment of secondary hydrocephalus(non-obstructive).Accurate preoperative evaluation and early intervention can achieve better surgical results. |
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