听神经瘤合并脑积水的诊疗策略

摘要

Objective To describe and analyze the strategy of the diagnosis and treatment for acoustic neuroma associated with hydrocephalus.Methods A retrospective review was performed in 29 patients with hydrocephalus associated with acoustic neuroma form Apr.2004 to Apr.2015.The patients' clinical information,the types of the hydrocephalus,the treatment and the prognosis of the hydrocephalus were recorded.Results There were 20 patients with obstructive hydrocephalus and 9 patients with communicating hydrocephalus preoperatively.Among the 29 cases,3 patients had ventriculoperitoneal shunts,5 patients had external ventricular drains,the remaining 21 patients had no further managements for hydrocephalus;after removing the acoustic neuroma,the hydrocephalus improved in 10 cases,the ventricle unchanged in 10 cases among the obstructive hydrocephalus group,the ventricle unchanged in all 9 cases among the communicating hydrocephalus group.Nineteen cases were diagnosed with communicating hydrocephalus and 10 cases with obstructive hydrocephalus postoperatively.Conclusions Among the patients of acoustic neuroma associated with hydrocephalus,communicating hydrocephalus is more common than obstructive hydrocephalus.The optimal management of acoustic neuroma associated with hydrocephalus is complete removal of the tumor,with treatment only for patients with persistent hydrocephalus.%目的 探讨听神经瘤合并脑积水患者的诊断及治疗策略.方法 收集2004年4月至2015年4月共29例听神经瘤合并脑积水患者的临床资料,回顾性分析脑积水发生的类型、治疗方法及预后.结果 术前诊断梗阻性脑积水20例,交通性脑积水9例.脑积水的治疗:3例行脑室腹腔分流术,5例听神经瘤术后行脑室外引流术,21例未进行任何治疗.听神经瘤切除术后,20例术前诊断梗阻性脑积水的患者中,10例脑室缩小,10例脑室无变化;9例术前诊断交通性脑积水患者术后脑室均无变化.术后诊断:交通性脑积水19例,梗阻性脑积水10例.结论 听神经瘤合并脑积水患者中,交通性脑积水比梗阻性脑积水更常见,治疗上以切除听神经瘤为主,不需要积极治疗脑积水.