Clinical outcomes of temporary shunting for infants with cerebral pseudomeningocele

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• 作者：Tobias A. Mattei (2)
  Deepak Sambhara (1)
  Brandon J. Bond (1)
  Julian Lin (2)
  
• 关键词：Pseudomeningocele ; Benign extra ; axial collection of infancy ; Temporary shunting ; CSF absorption ; Minor CSF pathways ; Arachnoid granulations ; Non ; accidental head trauma
• 刊名：Child's Nervous System
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：30
• 期：2
• 页码：283-291
• 全文大小：448 KB
• 作者单位：Tobias A. Mattei (2)
  Deepak Sambhara (1)
  Brandon J. Bond (1)
  Julian Lin (2)
  
  2. Department of Neurosurgery, Illinois Neurological Institute (INI), University of Illinois College of Medicine at Peoria (UICOMP), 530 NE Glen Oak, 61637, Peoria, IL, USA
  1. University of Illinois College of Medicine, Peoria, IL, USA
  
• ISSN：1433-0350

文摘

Objective Although in the case of subdural collections temporary shunting has been suggested as a viable alternative for definitive drainage of the accumulated fluid until restoration of the normal CSF dynamics, there is no agreement on the best management strategy for pseudomeningocele. Methods The authors performed a retrospective chart review in order to evaluate the clinical outcomes of infants temporarily shunted for pseudomeningocele without encephalocele at our institution (The University of Illinois at Peoria/Illinois Neurological Institute) in the period from 2004 to 2012. The epidemiological characteristics, clinical management, and final outcomes of such subpopulation were compared with a control group which received temporary shunting for subdural hematomas (SDH) during the same period. Results Four patients (100?% male) ranging in age from 8.9 to 27.1?months (mean--3.88) with pseudomeningocele and 17 patients (64.7?% male) ranging in age from 1.9 to 11.8?months (mean--.15) with SDH were identified. Although the initial management included sequential percutaneous subdural tapping in 82?% of the patients, all children ultimately failed such strategy, requiring either subdural–peritoneal (81?% of the cases) or subgaleal–peritoneal (19?% of the cases) shunting. The mean implant duration was 201?days for the pseudomeningocele group and 384?days for the SDH one. Mean post-shunt hospitalization was 2?days for patients with pseudomeningocele and 4?days for patients with SDH. There was no statistical difference in terms of complications, length of hospitalization post-shunting, or clinical outcomes between the patients with pseudomeningocele and those with SDH. Conclusions Temporary shunting of infants with pseudo-meningocele constitutes a viable therapeutic alternative with favorable clinical outcomes and a low risk of shunt dependency similar to those of children with SDH.