段階的に開窓術を行った髄膜炎後多房性水頭症の1例

Multiloculated Hydrocephalus Complicated by Meningitis and Ventriculitis Treated with Staged Fenestration:A Case Report

Ⅰ．はじめに

　脳室炎を伴う重篤な髄膜炎には，多房性水頭症が続発し治療に難渋することがある．特に新生児の髄膜炎では高頻度に脳室炎を合併し，約30%に隔壁形成を認めたとの報告がある⁵⁾．治療は髄液腔を単一化した上での脳室腹腔短絡術（ventriculoperitoneal shunt：VPS）であるが，経時的に髄液腔の構造が変化し，病態の収束までに複数のデバイスの導入を要する場合もある．しかし，感染やシャント不全などの合併症や，デバイスごとの流量管理の煩雑さを考慮すると，シャントシステムを最小限にとどめる必要がある．今回われわれはmultimodalityを駆使し，単一のシャントシステムで管理し得た髄膜炎後多房性水頭症の1例を経験したので報告する．

　Multiloculated hydrocephalus following severe meningitis with ventriculitis is often therapeutically challenging. Neonatal meningitis is commonly associated with ventricular inflammation, and approximately 30% of patients show septum formation. Although placement of a single ventriculoperitoneal shunt system could serve as optimal treatment for a multiloculated cerebrospinal cavity that is converted into a single chamber, multiple devices are often required for disease stability. We report a case of multiloculated hydrocephalus that occurred after meningitis in a patient who was successfully treated with a single shunt system using staged multimodality treatments.