neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2015-0-3-92-96neurosurgery-209Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWБЕРЕМЕННОСТЬ У ЖЕНЩИН С ГИДРОЦЕФАЛИЕЙ ПОСЛЕ ЛИКВОРОШУНТИРУЮЩИХ ОПЕРАЦИЙPregnancy at women with hydrocephalus after shunt operationsПорошниченкоАлександр ИгоревичPoroshnichenkoA. I.neyrogin@gmail.comБуршиновАлександр ОлеговичBurshinovA. O.noemail@neicon.ruРязанской области «Областной клинический перинатальный центр»Russian FederationРязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииRussian Federation201505102015039296Copyright © Порошниченко А.И., Буршинов А.О., 20152015Порошниченко А.И., Буршинов А.О.Poroshnichenko A.I., Burshinov A.O.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/209

В настоящее время все больше женщин, страдающих гидроцефалией и перенесших ликворошунтирующие операции, достигают детородного возраста. Беременность имеет сравнительно высокую частоту осложнений, таких как дисфункция шунта, вследствие повышения внутрибрюшного давления, вызванного беременной маткой. В обзоре обсуждаются вопросы влияния беременности на функцию вентрикуло-перитонеального шунта, представлены основные подходы к лечебной и акушерской тактике. При нормальном функционировании шунта рекомендуются естественные роды с укорочением второго периода родов. Кесарево сечение под наркозом показано при дисфункции шунта и внутричерепной гипертензии. Магнитно-резонансная томография рекомендуется как безопасный и эффективный метод оценки состояния желудочковой системы головного мозга и функционирования шунта. При функциональной окклюзии шунта возможно консервативное лечение в виде постельного режима и ручной прокачки помпы. Если выявлено увеличение размеров желудочков мозга, то требуется оперативное лечение. В первом и втором триместрах это может проводиться как у небеременных. В третьем триместре, в качестве альтернативы, рассматривается вентрикулоатриальное шунтирование или эндоскопическая тривентрикулоцистерностомия, с целью избежать индукции преждевременных родов и травматизации матки.

Nowadays a growing number of women suffered from hydrocephalus and underwent shunt operations are achieved reproductive age. Pregnancy has a relatively high incidence of complications, such as shunt malfunction due to raised intraabdominal pressure caused by gravid uterus. This article discusses the effect of pregnancy on the ventriculoperitoneal shunt function as well as presents the main approaches to the treatment and obstetric strategy. The vaginal delivery with shorten second stage is recommended in case of proper shunt functioning. The caesarean section performed under general anesthesia is indicated for patients with shunt malfunction and intracranial hypertension. Magnetic resonance imaging is recommended as a safe and effective method for evaluating the ventricular dimensions and assessment of shunt function. The conservative treatment such as bed rest and pumping shunt can be apply in functional shunt occlusion. The shunt revision is required in case of ventricular enlargement. This shunt revision during first and second trimesters of pregnancy can be performed in such a way as in case with non-pregnant patients. During the third trimester, ventriculoatrial shunt or third ventriculostomy may be considered as an alternative method, thereby avoiding the risks of uterine trauma or induction of preterm labour.

гидроцефалиябеременностьродывентрикуло-перитонеальное шунтированиедисфункция шунтакесарево сечениеэпидуральная анестезияhydrocephaluspregnancylaborventriculoperitoneal shuntshunt malfunctioncesarean sectionepidural anesthesiaReferencesBradley N.K., Liakos A.M., McAllister J.P. et al. Maternal shunt dependency: implications for obstetric care, neurological management, and pregnancy outcomes and a review of selected literature // Neurosurgery. - 1998. - Vol. 43. - p. 448-460.Bradley N.K., Liakos A.M., McAllister J.P. et al. Maternal shunt dependency: implications for obstetric care, neurological management, and pregnancy outcomes and a review of selected literature // Neurosurgery. - 1998. - Vol. 43. - p. 448-460.Bursac D., Kulas T., Persec J. et al. Pregnancy and vaginal delivery in epidural analgesia in woman with cerebrospinal fluid shunt // Coll antropol. - 2013. - Vol. 37 (4). - p. 1343-1345.Bursac D., Kulas T., Persec J. et al. Pregnancy and vaginal delivery in epidural analgesia in woman with cerebrospinal fluid shunt // Coll antropol. - 2013. - Vol. 37 (4). - p. 1343-1345.Chopra I., Gnanalingham K., Pal D., Peterson D. A knot in the catheter - an unusual cause of ventriculo-peritoneal shunt blockage // Acta neurochir (Wien). - 2004. - Vol. 146(9). - p. 1055-1056.Chopra I., Gnanalingham K., Pal D., Peterson D. A knot in the catheter - an unusual cause of ventriculo-peritoneal shunt blockage // Acta neurochir (Wien). - 2004. - Vol. 146(9). - p. 1055-1056.Cusimano M.D., Meffe F.M., Gentili F., Sermer M. Management of pregnant women with cerebrospinal fluid shunts // Pediatr Neurosurg. - 1991-1992. - Vol. 17(1). - p. 10-13.Cusimano M.D., Meffe F.M., Gentili F., Sermer M. Management of pregnant women with cerebrospinal fluid shunts // Pediatr Neurosurg. - 1991-1992. - Vol. 17(1). - p. 10-13.Fletcher H., Crandon I.W., Webster D. Maternal hydrocephalus in pregnancy and delivery: a report of two cases // West Indian Med J. - 2007. - Vol. 56(6). - p. 558-559.Fletcher H., Crandon I.W., Webster D. Maternal hydrocephalus in pregnancy and delivery: a report of two cases // West Indian Med J. - 2007. - Vol. 56(6). - p. 558-559.Freo U., Pitton M., Carron M., Ori C. Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery // Int J Obstet Anesth. - 2009. - Vol. 18. - p. 284-287.Freo U., Pitton M., Carron M., Ori C. Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery // Int J Obstet Anesth. - 2009. - Vol. 18. - p. 284-287.Hwang S.C., Kim T.H., Kim B.T. et al. Acute shunt malfunction after cesarean section delivery: a case report // J Korean Med Sci. - 2010. - Vol. 25(4). - p. 647-650.Hwang S.C., Kim T.H., Kim B.T. et al. Acute shunt malfunction after cesarean section delivery: a case report // J Korean Med Sci. - 2010. - Vol. 25(4). - p. 647-650.Kane J.M., Jackson K., Conway J.H. Maternal postpartum group B beta-hemolytic streptococcus ventriculoperitoneal shunt infection // Arch Gynecol Obstet. - 2004. - Vol. 269(2). - p. 139-141.Kane J.M., Jackson K., Conway J.H. Maternal postpartum group B beta-hemolytic streptococcus ventriculoperitoneal shunt infection // Arch Gynecol Obstet. - 2004. - Vol. 269(2). - p. 139-141.Kleinman G., Sutherling W., Martinez M., Tabsh K. Malfunction of ventriculoperitoneal shunts during pregnancy // Obstet Gynecol. - 1983. - Vol. 61(6). - p. 753-754.Kleinman G., Sutherling W., Martinez M., Tabsh K. Malfunction of ventriculoperitoneal shunts during pregnancy // Obstet Gynecol. - 1983. - Vol. 61(6). - p. 753-754.Landwehr J.B.Jr., Isada N.B., Pryde P.G. et al. Maternal neurosurgical shunts and pregnancy outcome // Obstet Gynecol. - 1994. - Vol. 83(1). - p. 134-137.Landwehr J.B.Jr., Isada N.B., Pryde P.G. et al. Maternal neurosurgical shunts and pregnancy outcome // Obstet Gynecol. - 1994. - Vol. 83(1). - p. 134-137.Liakos A.M., Bradley N.K., Magram G., Muszynski C. Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies // Neurol res. - 2000. - Vol. 22(1). - p. 69-88.Liakos A.M., Bradley N.K., Magram G., Muszynski C. Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies // Neurol res. - 2000. - Vol. 22(1). - p. 69-88.Littleford J.A., Brockhurst N.J., Bernstein E.P., Georgoussis S.E. Obstetrical anesthesia for a parturient with a ventriculoperitoneal shunt and third ventriculostomy // Can J Anaesth. - 1999. - Vol. 46(11). - p. 1057-1063.Littleford J.A., Brockhurst N.J., Bernstein E.P., Georgoussis S.E. Obstetrical anesthesia for a parturient with a ventriculoperitoneal shunt and third ventriculostomy // Can J Anaesth. - 1999. - Vol. 46(11). - p. 1057-1063.Maheut-Lourmiere J., Chu Tan Si. Hydrocepahalus during pregnancy with or without neurosurgical history in childhood. Practical advice for management // Neurchirurgie. - 2000. - Vol. 46(2). - p. 117-121.Maheut-Lourmiere J., Chu Tan Si. Hydrocepahalus during pregnancy with or without neurosurgical history in childhood. Practical advice for management // Neurchirurgie. - 2000. - Vol. 46(2). - p. 117-121.Mouelhi C., Srasra M., Zhioua F. et al. Maternal hydrocephaly and pregnancy. A new case report and review of the literature // Rev Fr Gynecol Obstet. - 1994. - Vol. 89(2). - p. 8890.Mouelhi C., Srasra M., Zhioua F. et al. Maternal hydrocephaly and pregnancy. A new case report and review of the literature // Rev Fr Gynecol Obstet. - 1994. - Vol. 89(2). - p. 8890.Murakami M., Morine M., Iwasa T. et al. Management of maternal hydrocephalus requires replacement of ventriculoperitoneal shunt with ventriculoatrial shunt: a case report // Arch Gynecol Obstet. - 2010. - Vol. 282(3). - p. 339-342.Murakami M., Morine M., Iwasa T. et al. Management of maternal hydrocephalus requires replacement of ventriculoperitoneal shunt with ventriculoatrial shunt: a case report // Arch Gynecol Obstet. - 2010. - Vol. 282(3). - p. 339-342.Ng J., Kitchen N. Neurosurgery and pregnancy // J Neurol Neurosurg Psychiatry. - 2008. - Vol. 79(7). - p. 745752.Ng J., Kitchen N. Neurosurgery and pregnancy // J Neurol Neurosurg Psychiatry. - 2008. - Vol. 79(7). - p. 745752.Nicolov A., Surchev Zh., Nalbanski B. et al. Pregnancy and delivery in women with cerebrospinal fluid shunt due to hydrocephalus // Akush Ginekol (Sofiia). - 2008. - Vol. 47(2). - p. 3-10.Nicolov A., Surchev Zh., Nalbanski B. et al. Pregnancy and delivery in women with cerebrospinal fluid shunt due to hydrocephalus // Akush Ginekol (Sofiia). - 2008. - Vol. 47(2). - p. 3-10.Okagaki A., Kanzaki H., Moritake K., Mori T. Case report: pregnant woman with ventriculoperitoneal shunt to treat hydrocephalus // Asia Oceania J Obstet Gynaecol. - 1990. - Vol. 16(2). - p. 111-113.Okagaki A., Kanzaki H., Moritake K., Mori T. Case report: pregnant woman with ventriculoperitoneal shunt to treat hydrocephalus // Asia Oceania J Obstet Gynaecol. - 1990. - Vol. 16(2). - p. 111-113.Perez-Lopez C., Duran P., Isla-Guerrero A., Alvarez F. Cerebrospinal fluid shunting and pregnancy // Rev Neurol. - 2003. - Vol. 36(9). - p. 872-876.Perez-Lopez C., Duran P., Isla-Guerrero A., Alvarez F. Cerebrospinal fluid shunting and pregnancy // Rev Neurol. - 2003. - Vol. 36(9). - p. 872-876.Riffaud L., Ferre J.C., Carsin-Nicol B., Morandi X. Endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus during pregnancy // Obstet Gynecol. - 2006. - Vol. 108 (3 Pt 2). - p. 801-804.Riffaud L., Ferre J.C., Carsin-Nicol B., Morandi X. Endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus during pregnancy // Obstet Gynecol. - 2006. - Vol. 108 (3 Pt 2). - p. 801-804.Samuels P., Driscoll D.A., Landon M.B. et al. Cerebrospinal fluid shunts in pregnancy. Report of two cases and review of the literature // Am J Perinatol. - 1988. - Vol. 5(1). - p. 22-25.Samuels P., Driscoll D.A., Landon M.B. et al. Cerebrospinal fluid shunts in pregnancy. Report of two cases and review of the literature // Am J Perinatol. - 1988. - Vol. 5(1). - p. 22-25.Sasagawa Y., Sasaki T., Fuji T. et al. Ventriculoperitoneal shunt malfunction due to pregnancy // No shinkei geka. - 2006. - Vol. 34(2). - p. 181-187.Sasagawa Y., Sasaki T., Fuji T. et al. Ventriculoperitoneal shunt malfunction due to pregnancy // No shinkei geka. - 2006. - Vol. 34(2). - p. 181-187.Schiza S., Stamatakis E., Panagopoulou A., Valsamidis D. Management of pregnancy and delivery of a patient with malfunctioning ventriculoperitoneal shunt // J Obstet Gynaecol. - 2012. - Vol. 32(1). - p. 6-9.Schiza S., Stamatakis E., Panagopoulou A., Valsamidis D. Management of pregnancy and delivery of a patient with malfunctioning ventriculoperitoneal shunt // J Obstet Gynaecol. - 2012. - Vol. 32(1). - p. 6-9.Sova M., Smrcka M., Baudysova O., Gogela J. Management of shunt malfunction during pregnancy // Bratisl Lek Listy. - 2001. - Vol. 102(12). - p. 562-563.Sova M., Smrcka M., Baudysova O., Gogela J. Management of shunt malfunction during pregnancy // Bratisl Lek Listy. - 2001. - Vol. 102(12). - p. 562-563.Wang X., Wang H., Fan Y. et al. Management of acute hydrocephalus due to pregnancy with ventriculoperitoneal shunt // Arch Gynecol Obstet. - 2013. - Vol. 288(5). - p. 1179-1182.Wang X., Wang H., Fan Y. et al. Management of acute hydrocephalus due to pregnancy with ventriculoperitoneal shunt // Arch Gynecol Obstet. - 2013. - Vol. 288(5). - p. 1179-1182.Watanabe Y., Oki S., Sumida M. et al. A case of aqueductal stenosis with acute progressive hydrocephalus during pregnancy // No shinkei geka. - 2005. - Vol. 33(1). - p. 59-63.Watanabe Y., Oki S., Sumida M. et al. A case of aqueductal stenosis with acute progressive hydrocephalus during pregnancy // No shinkei geka. - 2005. - Vol. 33(1). - p. 59-63.Wisoff J.H., Kratzert K.J., Handwerker S.M. et al. Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature // Neurosurgery. - 1991. - Vol. 29(6). - p. 827-831.Wisoff J.H., Kratzert K.J., Handwerker S.M. et al. Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature // Neurosurgery. - 1991. - Vol. 29(6). - p. 827-831.Yu J.N. Pregnancy and extracranial shunts: case report and review of the literature // J Fam Pract. - 1994. - Vol. 38(6). - p. 622-626.Yu J.N. Pregnancy and extracranial shunts: case report and review of the literature // J Fam Pract. - 1994. - Vol. 38(6). - p. 622-626.

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