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Neurological Surgery No Shinkei Geka Volume 39, Issue 5 （May 2011）

Neurological Surgery 脳神経外科 39巻5号（2011年5月発行）

Japanese English

症例

Lumboperitoneal shuntに特有な術後合併症--脊髄側チューブ硬膜貫通部の脇漏れによる硬膜外腔への髄液漏 Post-operative Complications Peculiar to Lumboperitoneal Shunt: Possible Consequences due to Side Leakage of CSF from around the Inserted Spinal Tube into the Lumbar Epidural Space 貝嶋光信 ¹ , 福田博 ¹ , 山本和秀 ¹ Mitsunobu KAIJIMA ¹ , Hiroshi FUKUDA ¹ , Kazuhide YAMAMOTO ¹ ¹北晨会恵み野病院脳神経外科 ¹Department of Neurosurgery,Hokushinkai Megumino Hospital キーワード： idiopathic normal pressure hydrocephalus , lumboperitoneal shunt , postoperative complication , CSF leakage , CSF over-drainage Keyword: idiopathic normal pressure hydrocephalus , lumboperitoneal shunt , postoperative complication , CSF leakage , CSF over-drainage pp.497-504

発行日 2011年5月10日 Published Date 2011/5/10

DOI https://doi.org/10.11477/mf.1436101433

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Ⅰ．はじめに

　Lumboperitoneal shunt（L-P shunt）は，ventriculoperitoneal shunt（V-P shunt）とともに，交通性水頭症の治療法として一般的に行われている¹¹⁾．とりわけ，近年治療の機会が増加して来ている特発性正常圧水頭症（idiopathic normal pressure hydrocephalus，iNPH）においては，その対象が高齢者であることが多いため，脳実質への直接的な手術侵襲がないL-P shuntを好んで選択する施設や術者が増えている²⁰⁾．

　われわれの施設ではこれまでに93例のL-P shuntを交通性水頭症の治療として行ってきた．そしてこのL-P shuntの術後合併症として，これまで言及されていない合併症に遭遇した．それは術後早期に起こる髄液過剰流出（CSF over-drainage）であり，その原因は，脊髄側チューブの硬膜貫通部からの髄液の硬膜外腔への髄液漏によるものであることを突き止めた．今後頻繁に行われると予測される本手術手技の合併症として警鐘的に報告する．

　This is a report on a few possible consequences of occasional side leakage of CSF into the lumbar epidural space. In this report,we refer to such CSF side leakage from around the inserted spinal tube which occurred during the early stages following our lumboperitoneal shunt operations in two of our patients. This leakage can lead to over-drainage of CSF,and such complications as post-operative orthostatic headache,subdural effusion,and/or subdural hematoma can also result. The diagnosis of these complications can be verified if CSF components in the lumbar epidural space are visible in T2 weighted-fat saturation images captured on MRI.

　Commonly,CSF over-drainage is attributed to improper pressure settings of the shunt valve and/or siphon effects of shunt systems induced by the patients’ postural changes. In addition to this,we strongly suggest anticipating the complications peculiar to lumboperitoneal shunt,because these are possible occurrences,although they have never been pointed out. In the surgical treatment of idiopathic normal pressure hydrocephalus,which is found mainly in elderly patients,increasing numbers of surgeons these days prefer lumboperitoneal shunt to ventriculoperitoneal shunt,as the former causes less damage to the brain. Given this trend towards lumboperitoneal shunt operations,we urge that the complications mentioned here be borne in mind as possible consequences.