neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2015-0-3-32-36neurosurgery-198Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTВЕНТРИКУЛЯРНОЕ ДРЕНИРОВАНИЕ ПРИ МАССИВНОМ ИНФАРКТЕ МОЗЖЕЧКА, ОСЛОЖНЕННОМ ОСТРОЙ ОККЛЮЗИОННОЙ ГИДРОЦЕФАЛИЕЙThe ventricular drainage at patients with massive cerebellar ischemic stroke complicated by acute occlusive hydrocephalusНикитинАндрей СергеевичNikitinA. S.zateya@bk.ruБуровСергей АлексеевичBurovS. A.noemail@neicon.ruАсратянСаркис АльбертовичAsratyanS. A.dr.sako1970@mail.ruГБУЗ «ГКБ №12 ДЗМ»Russian FederationФГКУ «ЦКВГ ФСБ России»Russian Federation201505102015033236Copyright © Никитин А.С., Буров С.А., Асратян С.А., 20152015Никитин А.С., Буров С.А., Асратян С.А.Nikitin A.S., Burov S.A., Asratyan S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/198

Цель исследования. Оценка эффективности вентрикулярного дренирования у пациентов с массивным инфарктом мозжечка, осложненным острой окклюзионной гидроцефалией (ООГ). Материал и методы. Проведен анализ результатов обследования и лечения 10 больных с массивным инфарктом мозжечка. У всех больных отмечено постепенное угнетение уровня бодрствования в результате развития ООГ. Всем больным провели вентрикулярное дренирование: 8 больным - наружное, 2 больным - имплантировали вентрикулоперитонеальный шунт. Декомпрессивную краниотомию (ДКТ) задней черепной ямки не выполняли ни одному больному. У пациентов был разный уровень бодрствования перед операцией: от глубокого оглушения, до глубокой комы. Результаты. Летальность составила 40%. У 8 пациентов после дренирования в течение ближайших суток было отмечено постепенное восстановление уровня бодрствования, из них далее 2 больных умерли от внечерепных осложнений. У 2 пациентов не отмечено восстановления уровня бодрствования после операции, они умерли от дислокации головного мозга. Заключение. Большинству больных с массивным инфарктом мозжечка, осложненным ООГ, достаточно выполнить только дренирование желудочковой системы. В случае отсутствия положительной динамики неврологического статуса в первые 24 часа после операции показано проведение ДКТ задней черепной ямки. Глубокая кома не является противопоказанием к операции у данной категории больных.

Objective. To analyze the effectiveness of ventricular drainage at patients with massive cerebellar ischemic stroke complicated by development of acute occlusive hydrocephalus (AOH). Material and methods. We analyzed the results of examination and treatment of 10 patients with massive cerebellar ischemic stroke. All patients underwent the gradual depression of conscious level because of AOH development. All patients underwent ventricular drainage, among them 8 - external and 2 - ventriculoperitoneal shunt. Decompressive craniotomy of posterior cranial fossa was not performed at any patient. All patients had different level of conscious before operation - from deep stupor to deep coma. Results. The lethality was 40%. The gradual restoration of conscious level was seen at 8 patients during the following day after ventricular drainage, among them 2 patients died from extracranial complications. There was no restoration of conscious level after operation at 2 patients and they died from brain dislocation. Conclusion. The only ventricular drainage is enough for majority of patients with massive cerebellar ischemic stroke complicated with AOH. The decompressive craniotomy of posterior cranial fossa is indicative for patients with no improvement in neurological status during first 24 hours after ventricular drainage. The deep coma is not the contraindication for operation at such patients.

массивный инфаркт мозжечкаострая окклюзионная гидроцефалиянаружное вентрикулярное дренированиеmassive cerebellar ischemic strokeacute occlusive hydrocephalusexternal ventricular drainageReferencesВерещагин Н.В., Пирадов М.А. Интенсивная терапия острых нарушений мозгового кровообращения // Медицинская газета. - 1999. - № 43. - C.2-3.Верещагин Н.В., Пирадов М.А. Интенсивная терапия острых нарушений мозгового кровообращения // Медицинская газета. - 1999. - № 43. - C.2-3.Гусев Е.И., Скворцова В.И. Ишемия головного мозга: монография. - М.: Медицина, 2001. - С.12-13.Гусев Е.И., Скворцова В.И. Ишемия головного мозга: монография. - М.: Медицина, 2001. - С.12-13.Andoh T, Sakai N, Yamada H, Hattori T, Miwa Y, Hirata T, Tanabe Y, Ohkuma A, Funakoshi T, Takada M. Cerebellar infarction: analysis of 33 cases. // Stroke. - 1987. - Vol.18(5). - P. 849-855.Andoh T, Sakai N, Yamada H, Hattori T, Miwa Y, Hirata T, Tanabe Y, Ohkuma A, Funakoshi T, Takada M. Cerebellar infarction: analysis of 33 cases. // Stroke. - 1987. - Vol.18(5). - P. 849-855.Baldauf J, Oertel J, Gaab M, Schroeder H. Endoscopic third ventriculostomy for occlusive hydrocephalus caused by cerebellar infarction // Neurosurgery. - 2006. - Vol. 59(3). - P. 539-544.Baldauf J, Oertel J, Gaab M, Schroeder H. Endoscopic third ventriculostomy for occlusive hydrocephalus caused by cerebellar infarction // Neurosurgery. - 2006. - Vol. 59(3). - P. 539-544.Bertalanffy H, Vries J. Management of cerebellar infarction with associated occlusive hydrocephalus // Stroke. - 1983. - Vol. 14(5). - P. 745-751.Bertalanffy H, Vries J. Management of cerebellar infarction with associated occlusive hydrocephalus // Stroke. - 1983. - Vol. 14(5). - P. 745-751.Busse O, Laun A, Agnoli A. Obstructive hydrocephalus in cerebellar infarcts // Fortschr Neurol Psychiatr. - 1984. - Vol. 52(5). - P.164-171.Busse O, Laun A, Agnoli A. Obstructive hydrocephalus in cerebellar infarcts // Fortschr Neurol Psychiatr. - 1984. - Vol. 52(5). - P.164-171.Caplan L. Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome // Stroke. - 1979. - Vol. 10. - P. 277-282.Caplan L. Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome // Stroke. - 1979. - Vol. 10. - P. 277-282.Chen H, Lee T, Wei C. Treatment of cerebellar infarction by decompressive suboccipital craniectomy // Stroke. - 1992. - Vol.23(7). - P. 957-961.Chen H, Lee T, Wei C. Treatment of cerebellar infarction by decompressive suboccipital craniectomy // Stroke. - 1992. - Vol.23(7). - P. 957-961.Czernicki T, Marchel A. Results of treatment of cerebellar infarctions // Neurol Neurochir Pol. - 2004. - Vol.38(1). - P. 37-43.Czernicki T, Marchel A. Results of treatment of cerebellar infarctions // Neurol Neurochir Pol. - 2004. - Vol.38(1). - P. 37-43.Greenberg J, Skubick D, Shenkin H. Acute hydrocephalus in cerebellar infarct and hemorrhage // Neurology. - 1979. - Vol. 29. - P. 409-413.Greenberg J, Skubick D, Shenkin H. Acute hydrocephalus in cerebellar infarct and hemorrhage // Neurology. - 1979. - Vol. 29. - P. 409-413.Hornig C, Rust D, Busse O, Jauss M, Laun A. Space-occupying cerebellar infarction. Clinical course and prognosis // Stroke. - 1994. - Vol.25(2). - P. 372-374.Hornig C, Rust D, Busse O, Jauss M, Laun A. Space-occupying cerebellar infarction. Clinical course and prognosis // Stroke. - 1994. - Vol.25(2). - P. 372-374.Jauss M, Krieger D, Hornig C, Schramm J, Busse O. Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study // J Neurol. - 1999. - Vol. 246 (4). - P. 257-264.Jauss M, Krieger D, Hornig C, Schramm J, Busse O. Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study // J Neurol. - 1999. - Vol. 246 (4). - P. 257-264.Keidel M, Galle G, Wiedmayer J, Taghavy A. Malignant cerebellar infarct // Fortschr Neurol Psychiatr. - 1984. - Vol. 52(8). - P.277-283.Keidel M, Galle G, Wiedmayer J, Taghavy A. Malignant cerebellar infarct // Fortschr Neurol Psychiatr. - 1984. - Vol. 52(8). - P.277-283.Khan I, Burhan Ud din Janjua M, Khatri I, Nadeem M. Surgical decompression in massive cerebellar stroke // RMJ. - 2010. - Vol. 35(1). - P. 96-100.Khan I, Burhan Ud din Janjua M, Khatri I, Nadeem M. Surgical decompression in massive cerebellar stroke // RMJ. - 2010. - Vol. 35(1). - P. 96-100.Khan M, Polyzoidis K, Adegbite A, McQueen J. Massive cerebellar infarction: “conservative” management // Stroke. - 1983. - Vol. 14. - P. 745-751.Khan M, Polyzoidis K, Adegbite A, McQueen J. Massive cerebellar infarction: “conservative” management // Stroke. - 1983. - Vol. 14. - P. 745-751.Kim J, Lee J, Suh D, Lee M. Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects // Stroke. - 1994. - Vol. 25. - P. 1405-1410.Kim J, Lee J, Suh D, Lee M. Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects // Stroke. - 1994. - Vol. 25. - P. 1405-1410.Klugkist H, McCarthy J. Surgical treatment of space-occupying cerebellar infarctions years post-operative follow-up // Neurosurgical review. - 1991. - Vol. 14. - P. 17-22.Klugkist H, McCarthy J. Surgical treatment of space-occupying cerebellar infarctions years post-operative follow-up // Neurosurgical review. - 1991. - Vol. 14. - P. 17-22.Koh M, Phan T, Atkinson J, Wijdicks E. Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect // Stroke. - 2000. - Vol.31. - P. 2062-2067.Koh M, Phan T, Atkinson J, Wijdicks E. Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect // Stroke. - 2000. - Vol.31. - P. 2062-2067.Krieger D, Busse O, Schramm J, et al. German-Austrian space occupying cerebellar infarction study // J Neurol. - 1992. - Vol. 239. - P. 47-49.Krieger D, Busse O, Schramm J, et al. German-Austrian space occupying cerebellar infarction study // J Neurol. - 1992. - Vol. 239. - P. 47-49.Kudo H, Kawaguchi T, Minami H, Kuwamura K, Miyata M, Kohmura E. Controversy of surgical treatment for severe cerebellar infarction //. - 2007. - Vol.16(6). - P. 259-262.Kudo H, Kawaguchi T, Minami H, Kuwamura K, Miyata M, Kohmura E. Controversy of surgical treatment for severe cerebellar infarction //. - 2007. - Vol.16(6). - P. 259-262.Laun A, Busse O, Calatayud V, Klug N. Cerebellar infarcts in the area of the supply of the PICA and their surgical treatment // Lancet. - 1982. - Vol.2(8295). - P.429-432Laun A, Busse O, Calatayud V, Klug N. Cerebellar infarcts in the area of the supply of the PICA and their surgical treatment // Lancet. - 1982. - Vol.2(8295). - P.429-432Levada O.A. Etiology, clinical variants, diagnosis and treatment tactic of cerebellar infarction // Lik Sprava. - 2003. - Vol.5. - P.3-6.Levada O.A. Etiology, clinical variants, diagnosis and treatment tactic of cerebellar infarction // Lik Sprava. - 2003. - Vol.5. - P.3-6.Macdonell R, Kalnins R, Donnan G. Cerebellar infarction: natural history, prognosis, and pathology // Arch Neurol. - 1975. - Vol. 32(6). - P. 357-363.Macdonell R, Kalnins R, Donnan G. Cerebellar infarction: natural history, prognosis, and pathology // Arch Neurol. - 1975. - Vol. 32(6). - P. 357-363.Mathew P, Teasdale G, Bannan A, Oluoch-Olunya D. Neurosurgical management of cerebellar haematoma and infarct // Journal of Neurology, Neurosurgery, and Psychiatry. - 1995. - Vol.59. - P. 287-292.Mathew P, Teasdale G, Bannan A, Oluoch-Olunya D. Neurosurgical management of cerebellar haematoma and infarct // Journal of Neurology, Neurosurgery, and Psychiatry. - 1995. - Vol.59. - P. 287-292.Milandre L, Brosset C, Gouirand R, Khalil R. Pure cerebellar infarction. Thirty cases // Presse Med. - 1992. - Vol.21(33). - P.1562-1565.Milandre L, Brosset C, Gouirand R, Khalil R. Pure cerebellar infarction. Thirty cases // Presse Med. - 1992. - Vol.21(33). - P.1562-1565.Mohr J. Stroke: Pathophysiology, Diagnosis, and Management 5th ed. Philadelphia: Elsevier Inc, 2011. - P. 750-752.Mohr J. Stroke: Pathophysiology, Diagnosis, and Management 5th ed. Philadelphia: Elsevier Inc, 2011. - P. 750-752.Mohsenipour I, Gabl M, Schutzhard E, Twerdy K. Suboccipital decompressive surgery in cerebellar infarction // Zentralbl Neurochir. - 1999. - Vol. 60 (2). - P. 68-73.Mohsenipour I, Gabl M, Schutzhard E, Twerdy K. Suboccipital decompressive surgery in cerebellar infarction // Zentralbl Neurochir. - 1999. - Vol. 60 (2). - P. 68-73.Ogasawara K, Koshu K, Nagamine Y, Fujiwara S, Mizoi K, Yoshimoto T. Surgical decompression for massive cerebellar infarction // No Shinkei Geka. - 1995. - Vol.23(1). - P. 43-48.Ogasawara K, Koshu K, Nagamine Y, Fujiwara S, Mizoi K, Yoshimoto T. Surgical decompression for massive cerebellar infarction // No Shinkei Geka. - 1995. - Vol.23(1). - P. 43-48.Orz Y, Naggar A, Issa A, Aref K, Abdeen K. Posterior fossa decompression in acute cerebellar infarction // Pan Arab Journal of Neurosurgery. - 2008.- Vol.12 (1)Orz Y, Naggar A, Issa A, Aref K, Abdeen K. Posterior fossa decompression in acute cerebellar infarction // Pan Arab Journal of Neurosurgery. - 2008.- Vol.12 (1)Ramos-Zuwga R, Jimonez-Guerra R. Rational management of transient obstructive hydrocephalus secondary to a cerebellar infarct // Minim Invasive Neurosurg. - 2006. - Vol. 49(5). - P. 302-304.Ramos-Zuwga R, Jimonez-Guerra R. Rational management of transient obstructive hydrocephalus secondary to a cerebellar infarct // Minim Invasive Neurosurg. - 2006. - Vol. 49(5). - P. 302-304.Shenkin H, Zavala M. Cerebellar strokes: mortality, surgical indications, and results of ventricular drainage // Rev Neurol (Paris). - 1994. - Vol.150(3). - P. 209-215.Shenkin H, Zavala M. Cerebellar strokes: mortality, surgical indications, and results of ventricular drainage // Rev Neurol (Paris). - 1994. - Vol.150(3). - P. 209-215.Sypert G, Alvord E. Cerebellar infarction. A clinicopathological study //. Acta Neurochir (Wien). - 1984. - Vol. 71(3). - P. 295-306.Sypert G, Alvord E. Cerebellar infarction. A clinicopathological study //. Acta Neurochir (Wien). - 1984. - Vol. 71(3). - P. 295-306.Tohgi H, Takahashi S, Chiba K, Hirata Y. Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group // Stroke. - 1993. - Vol. 24(1). - P. 1697-1701.Tohgi H, Takahashi S, Chiba K, Hirata Y. Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group // Stroke. - 1993. - Vol. 24(1). - P. 1697-1701.Yoshimura K, Kubo S, Nagashima M, Hasegawa H, Thminaga S, Yoshimine T. Occlusive hydrocephalus associated with cerebellar infarction treated with endoscopic third ventriculostomy: report of 5 cases // Minim Invasive Neurosurg. - 2007. - Vol. 50(5). - P. 270-272.Yoshimura K, Kubo S, Nagashima M, Hasegawa H, Thminaga S, Yoshimine T. Occlusive hydrocephalus associated with cerebellar infarction treated with endoscopic third ventriculostomy: report of 5 cases // Minim Invasive Neurosurg. - 2007. - Vol. 50(5). - P. 270-272.

The authors declare that there are no conflicts of interest present.