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Neurological Surgery No Shinkei Geka Volume 48, Issue 7 （July 2020）

Neurological Surgery 脳神経外科 48巻7号（2020年7月発行）

Japanese English

症例

圧可変式シャントバルブの偶発的な設定圧変化により，脳室側チューブ周囲に浮腫を伴う脳実質内囊胞を形成した交通性水頭症の稀な成人例 A Rare Case of Communicating Hydrocephalus with Intraparenchymal Pericatheter Cyst and Surrounding Edema in an Adult due to Accidental Change in the Pressure Setting of the Programmable Shunt System 原口渉 ¹ , 松尾彩香 ¹ , 日宇健 ¹ , 伊藤健大 ¹ , 森塚倫也 ¹ , 本田和也 ¹ , 川原一郎 ¹ , 小野智憲 ¹ , 牛島隆二郎 ¹ , 堤圭介 ¹ Wataru HARAGUCHI ¹ , Ayaka MATSUO ¹ , Takeshi HIU ¹ , Takehiro ITO ¹ , Tomoya MORITSUKA ¹ , Kazuya HONDA ¹ , Ichiro KAWAHARA ¹ , Tomonori ONO ¹ , Ryujiro USHIJIMA ¹ , Keisuke TSUTSUMI ¹ ¹国立病院機構長崎医療センター脳神経外科 ¹Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center キーワード： intraparenchymal pericatheter cyst , reversible porencephalic cyst , ventriculoperitoneal-shunt dysfunction（malfunction) , programmable shunt valve , accidental resetting of a CODMAN^® HAKIM^® programmable valve Keyword: intraparenchymal pericatheter cyst , reversible porencephalic cyst , ventriculoperitoneal-shunt dysfunction（malfunction) , programmable shunt valve , accidental resetting of a CODMAN^® HAKIM^® programmable valve pp.633-640

発行日 2020年7月10日 Published Date 2020/7/10

DOI https://doi.org/10.11477/mf.1436204243

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　脳室腹腔（ventriculoperitoneal：VP）シャント機能不全に伴って，脳室側チューブ周囲に脳浮腫や髄液を貯留する脳実質内囊胞（intraparenchymal pericatheter cyst：IPC）を形成した報告は散見されるが，小児例が主体である⁶⁾．今回われわれは，くも膜下出血（subarachnoid hemorrhage：SAH）に合併した交通性水頭症に対し，CODMAN^® HAKIM^® programmable valve system（CHPV）（Integra LifeSciences, New Jersey, USA）を用いてVPシャント術を施行した9年後，偶発的な設定圧変化に伴ってIPCと周囲浮腫を合併したと考えられる稀な成人例を経験した．本病態の発生機序や既報例の臨床像等について，文献的考察を加えて報告する．

　A 59-year-old woman suffering from memory impairment visited our hospital. She was discharged nine years ago without complications after undergoing neck clipping surgery for intracranial aneurysm rupture and a right ventricular peritoneal shunt using the CODMAN^® HAKIM^® programmable valve system（CHPV）for hydrocephalus.

　Initial CT/MRI revealed a cystic lesion with surrounding edema in the right frontal lobe around the proximal catheter, and a left frontal subacute subdural hematoma. The right ventricle was shown as a slit as before. The cystic portion presented with an MRI signal of the same intensity as the cerebrospinal fluid（CSF), and no enhancement effect was observed. It was thought to be a CSF cyst around the shunt catheter with interstitial CSF edema. Skull radiographs showed an accidental change in the CHPV pressure setting（100 to 190mmH₂O), possibly due to head impact. We concluded that the newly set valve pressure caused sudden shunt dysfunction, resulting in CSF cyst formation and surrounding edema. Image findings and her symptoms were immediately improved on adjusting the shunt valve.

　This complication in adults associated with shunt dysfunction is very rare and only 10 cases have been reported to date. This is the first report of this complication due to an accidental reset of CHPV. To prevent the risk of misdiagnosing this condition as a tumor or abscess and performing unnecessary surgery, it is always necessary to suspect the possibility of this complication. For that purpose, detailed images, including diffusion-weighted images and contrast-enhanced MRI, should be done early in clinical practice.