多模态辅助定位在合并颅骨缺损脑积水脑室-腹腔分流术中的临床应用

doi:10.3877/cma.j.issn.2095-9141.2026.01.004

目的

探讨术前Mark联合术中超声多模态辅助定位在合并颅骨缺损脑积水患者脑室-腹腔分流术中的临床应用价值。

方法

回顾性分析苏州市相城人民医院神经外科自2019年1月至2024年1月收治的46例脑积水合并颅骨缺损行脑室-腹腔分流术患者的临床资料，其中26例患者采用术前Mark定位联合术中超声多模态技术完成手术（改良手术组），20例采用传统方法完成手术（传统手术组）。比较2组患者的穿刺置管精度、穿刺次数、手术时间及围术期并发症发生率。术后随访3~24个月，采用改良Rankin量表（mRS）评估2组患者的功能恢复情况。

结果

改良手术组患者的分流管脑室端放置位置明显优于传统手术组，穿刺次数少于传统手术组，差异均有统计学意义（P<0.05）。2组患者的手术用时、围术期并发症发生率比较，差异均无统计学意义（P>0.05）。随访3~24个月，2组患者的mRS评分分布差异有统计学意义（P<0.05），但总有效率差异无统计学意义（P>0.05）。

结论

合并颅骨缺损的脑积水患者行脑室-腹腔分流术中采用术前Mark定位联合术中超声引导，脑室端放置更精确，成本更低。

关键词: 脑积水, 颅骨缺损, 脑室-腹腔分流术, Mark定位, 术中超声, 多模态

Objective

To investigate the clinical value of preoperative Mark combined with intraoperative ultrasound multimodal assisted localization in ventriculo-peritoneal shunt for the treatment of hydrocephalus and skull defects.

Methods

A retrospective analysis was conducted on the clinical data of 46 patients with hydrocephalus and skull defects who underwent ventriculo-peritoneal shunt surgery in the Neurosurgery Department of Suzhou Xiangcheng People's Hospital from January 2019 to January 2024. Among them, 26 patients underwent surgery using preoperative Mark positioning combined with intraoperative ultrasound multimodal technology (modified surgery group), and 20 patients underwent surgery using traditional methods (traditional surgery group). The accuracy of puncture catheterization, number of punctures, surgical time, and perioperative complications were compared between two groups of patients. Follow up for 3-24 months after surgery was conducted to evaluate the functional recovery of two groups of patients using the modified Rankin scale (mRS).

Results

The position of the ventricular catheter position in the modified surgery group was significantly better than that in the traditional surgery group, and the number of punctures was less than that in the traditional surgery group, with statistically significant differences (P<0.05). There was no statistically significant difference in the surgical time and incidence of perioperative complications between the two groups of patients (P>0.05). During the follow-up period of 3-24 months, there was a statistically significant difference in the distribution of mRS scores between the two groups of patients (P<0.05), but there was no statistically significant difference in the total effective rate (P>0.05).

Conclusions

In patients with hydrocephalus complicated by skull defects, the use of preoperative Mark localization and intraoperative ultrasound guidance during ventriculo-peritoneal shunt surgery is more accurate with low cost.

Key words: Hydrocephalus, Skull defect, Ventriculo-peritoneal shunt, Mark positioning, Ntraoperative ultrasound, Multimodal

图1 去骨瓣减压术后合并脑积水患者行多模态辅助脑室-腹腔分流术术前Mark标记及计划靶点设定A：水平位；B：矢状位；C：冠状位；D：三维模拟图

Fig.1 Preoperative Mark marking and planned target setting for multimodal assisted ventriculo-peritoneal shunt surgery in patients with hydrocephalus after decompressive craniectomy

图2 去骨瓣减压术后合并脑积水患者行多模态辅助脑室-腹腔分流术术中实时引导脑室端超声及术后CT影像A：术中超声引导分流管头端进入侧脑室；B：术中超声引导分流管头端到达侧脑室室间孔附近；C：术后第2天CT示分流管进入脑室位置；D：术后第2天CT示分流管头端位于脑室室间孔附近

Fig.2 Real-time ultrasound guidance for intraventricular catheter placement and postoperative CT imaging during multimodal-assisted ventriculo-peritoneal shunt surgery in patients with hydrocephalus following decompressive craniectomy

表1 2组去骨瓣减压术后合并脑积水患者穿刺置管精度比较[例（%）]

Tab.1 Comparison of puncture and catheter placement accuracy between two groups of patients with hydrocephalus after decompressive craniectomy [n(%)]

组别	例数	位置理想	位置一般	位置差
改良手术组	26	20（76.9）	6（23.1）	0
传统手术组	20	1（5.0）	11（55.0）	8（40.0）
χ²值		23.570	4.890	-
P值		<0.001	0.027	<0.001

表1 2组去骨瓣减压术后合并脑积水患者穿刺置管精度比较[例（%）]

Tab.1 Comparison of puncture and catheter placement accuracy between two groups of patients with hydrocephalus after decompressive craniectomy [n(%)]

组别	例数	位置理想	位置一般	位置差
改良手术组	26	20（76.9）	6（23.1）	0
传统手术组	20	1（5.0）	11（55.0）	8（40.0）
χ²值		23.570	4.890	-
P值		<0.001	0.027	<0.001

表2 2组去骨瓣减压术后合并脑积水患者mRS评分比较[例（%）]

Tab.2 Comparison of mRS scores between two groups of patients with hydrocephalus after decompressive craniectomy [n(%)]

组别	例数	显效	有效	一般	差	总有效率
改良手术组	26	15（57.7）	6（23.1）	3（11.5）	2（7.6）	21（80.8）
传统手术组	20	5（25.0）	6（30.0）	3（15.0）	6（30.0）	11（55.0）
Z/χ²值		-2.420				3.456
P值		0.023				0.063

表2 2组去骨瓣减压术后合并脑积水患者mRS评分比较[例（%）]

Tab.2 Comparison of mRS scores between two groups of patients with hydrocephalus after decompressive craniectomy [n(%)]

组别	例数	显效	有效	一般	差	总有效率
改良手术组	26	15（57.7）	6（23.1）	3（11.5）	2（7.6）	21（80.8）
传统手术组	20	5（25.0）	6（30.0）	3（15.0）	6（30.0）	11（55.0）
Z/χ²值		-2.420				3.456
P值		0.023				0.063

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Clinical application of multimodal assisted localization in ventriculo-peritoneal shunt for the treatment of hydrocephalus with skull defects

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Clinical application of multimodal assisted localization in ventriculo-peritoneal shunt for the treatment of hydrocephalus with skull defects