小児水頭症における最良の手術とデバイスの選択
小児水頭症の治療目標は, 正常な成長・発達を目指すことであり, 将来を見据えて手術適応や手術方法を選択しなければならない. 2014年に小児水頭症ガイドラインが発表され, 2020年に見直しが行われた. 抗生剤含浸カテーテルのエビデンスレベルが3から1になったこと, 出血後水頭症に対する治療として内視鏡下脳室内洗浄がレベル3のオプションとして加わったことが改訂点である. 本稿では患児にとって最適な治療方法を選択し, 合併症のない安全な手術が行えるように, ガイドラインを中心とした最新のエビデンスと著者の経験から最良の手術とデバイスについて考察する....
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| Published in | 脳神経外科ジャーナル Vol. 30; no. 6; pp. 432 - 437 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.30.432 |
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| Abstract | 小児水頭症の治療目標は, 正常な成長・発達を目指すことであり, 将来を見据えて手術適応や手術方法を選択しなければならない. 2014年に小児水頭症ガイドラインが発表され, 2020年に見直しが行われた. 抗生剤含浸カテーテルのエビデンスレベルが3から1になったこと, 出血後水頭症に対する治療として内視鏡下脳室内洗浄がレベル3のオプションとして加わったことが改訂点である. 本稿では患児にとって最適な治療方法を選択し, 合併症のない安全な手術が行えるように, ガイドラインを中心とした最新のエビデンスと著者の経験から最良の手術とデバイスについて考察する. |
|---|---|
| AbstractList | 小児水頭症の治療目標は, 正常な成長・発達を目指すことであり, 将来を見据えて手術適応や手術方法を選択しなければならない. 2014年に小児水頭症ガイドラインが発表され, 2020年に見直しが行われた. 抗生剤含浸カテーテルのエビデンスレベルが3から1になったこと, 出血後水頭症に対する治療として内視鏡下脳室内洗浄がレベル3のオプションとして加わったことが改訂点である. 本稿では患児にとって最適な治療方法を選択し, 合併症のない安全な手術が行えるように, ガイドラインを中心とした最新のエビデンスと著者の経験から最良の手術とデバイスについて考察する. |
| Author | 原田, 敦子 |
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| Copyright | 2021 日本脳神経外科コングレス |
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| DOI | 10.7887/jcns.30.432 |
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| References | 11) Klimo P Jr, Van Poppel M, Thompson CJ, Baird LC, Duhaime AC, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 6 : Preoperative antibiotics for shunt surgery in children with hydrocephalus : a systematic review and meta-analysis. J Neurosurg Pediatr 14 (Suppl) : 44-52, 2014. 13) Kulkarni AV, Sgouros S, Constantini S ; IIHS Investigators : International infant hydrocephalus study : initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy and shunt for infant hydrocephalus. Childs Nerv Syst 32 : 1039-1048, 2016. 3) Flannery AM, Duhaime AC, Tamber MS, Kemp J ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 3 : Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement. J Neurosurg Pediatr 14 suppl : 24-29, 2014. 21) Tamber MS, Klimo P Jr, Mazzola CA, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 8 : Management of cerebrospinal shunt infection. J Neurosurg Pediatr 14 suppl : 60-71, 2014. 22) Tamber MS, Kestle JRW, Reeder RW, Holubkov R, Alvey J, Browd SR, Drake JM, Kulkarni AV, Limbrick DD, McDonald PJ, Rozzelle CJ, Simon TD, Naftel R, Shannon CN, Wellons JC, Whitehead WE, Riva-Cambrin J ; Hydrocephalus Clinical Research Network : Temporal trends in surgical procedures for pediatric hydrocephalus : an analysis of the Hydrocephalus Clinical Research Network core data project. J Neurosurg Pediatr [Epub ahead of print] . 8) Kemp J, Flannery AM, Tamber MS, Duhaime AC ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 9 : Effect of ventricular catheter entry point and position. J Neurosurg Pediatr 14 suppl : 72-76, 2014. 5) 原田敦子 : 小児①水頭症. 吉村紳一監, 吉本幸司編 : 専門医なら知っておきたい疾患・術式別脳神経外科手術合併症の回避・対処法Q & A156. 大阪, メディカ出版, 2019, pp.240-245. 16) Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD Jr, Rogido M, Mitchell L, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 2 : Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14 (suppl) : 8-23, 2014. 19) Schulz M, Bührer C, Pohl-Schickinger A, Haberl H, Thomale UW : Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr 13 : 626-635, 2014. 17) 宮嶋雅一, 下地一彰, 木村孝興, 新井 一 : 米国ガイドラインに基づいた小児水頭症の標準治療―小児水頭症に対する今日の最善の治療法は何か？―. 脳外誌 26 : 564-573, 2017. 20) Simon TD, Kronman MP, Whitlock KB, Gove NE, Mayer-Hamblett N, Browd SR, Cochrane DD, Holubkov R, Kulkarni AV, Langley M, Limbrick DD, Luerssen TG, Oakes WJ, Riva-Cambrin J, Rozzelle C, Shannon C, Tamber M, Wellons JC, Whitehead WE, Kestle JRW : Reinfection after treatment of first cerebrospinal fluid shunt infection : a prospective observational cohort study. J Neurosurg Pediatr 21 : 346-358, 2018. 1) Baird LC, Mazzola CA, Auguste KI, Klimo P Jr, Flannery AM : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 5 : Effect of valve type on cerebrospinal fluid shunt efficacy. J Neurosurg Pediatr 14 (Suppl) : 35-43, 2014. 14) Limbrick DD Jr, Baird LC, Klimo P Jr, Riva-Cambrin J, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 4 : Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr 14 Suppl : 30-34, 2014. 15) Mallucci CL, Jenkinson MD, Conroy EJ, Hartley JC, Brown M, Dalton J, Kearns T, Moitt T, Griffiths MJ, Culeddu G, Solomon T, Hughes D, Gamble C ; BASICS Study collaborators : Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS) : a multicentre, single-blinded, randomized trial and economic evaluation. Lancet 394 : 1530-1539, 2019. 10) Kestle JRW, Holubkov R, Cochrane DD, Kulkarni AV, Limbrick DD Jr, Luerssen TG, Oakes WJ, Riva-Cambrin J, Rozzelle C, Simon TD, Walker ML, Wellons JC 3rd, Browd SR, Drake JM, Shannon CN, Tamber MS, Whitehead WE ; Hydrocephalus Clinical Research Network : A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr 17 : 391-396, 2016. 9) Kestle JRW, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R ; Hydrocephalus Clinical Research Network : A standardized protocol to reduce cerebrospinal fluid shunt infection : The Hydrocephalus Clinical Research Network quality improvement initiative. J Neurosurg Pediatr 8 : 22-29, 2011. 18) Nikas DC, Post AF, Choudhri AF, Mazzola CA, Mitchell L, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 10 : Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr 14 suppl : 77-81, 2014. 7) Hsu CH, Chou SC, Yang SH, Shih MC, Kuo MF : Using a burr hole valve prevents proximal shunt failure in infants and toddlers. J Neurosurg Pediatr 24 : 315-322, 2019. 12) Klimo P Jr, Thompson CJ, Baird LC, Flannery AM : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 7 : Antibiotics-impregnated shunt systems versus conventional shunts in children : a systematic review and meta-analysis. J Neurosurg Pediatr (suppl) 14 : 53-59, 2014. 2) Bauer DF, Baird LC, Klimo P Jr, Mazzola CA, Nikas DC, Tamber MS, Flannery AM : Congress of Neurological Surgeons systematic review and evidence-based guidelines on the treatment of pediatric hydrocephalus : update of the 2014 guidelines. Neurosurgery 87 : 1071-1075, 2020. 4) 原田敦子 : 小児水頭症に対するVPシャント術 vs. 神経内視鏡手術―現状と課題―. 脳外誌 27 : 646-652, 2018. 6) Hayashi T, Shirane R, Yokosawa M, Kimiwada T, Tominaga T : Efficacy of intraoperative irrigation with saline for preventing shunt infection. J Neurosurg Pediatr 6 : 273-276, 2010. 23) Thomale UW, Cinalli G, Kulkarni AV, Al-Hakim S, Roth J, Schaumann A, Bührer C, Cavalheiro S, Sgouros S, Constantini S, Bock HC : TROPHY registry study design : a prospective, international multicenter study for the surgical treatment of posthemorrhagic hydrocephalus in neonates. Childs Nerv Syst 35 : 613-619, 2019. |
| References_xml | – reference: 23) Thomale UW, Cinalli G, Kulkarni AV, Al-Hakim S, Roth J, Schaumann A, Bührer C, Cavalheiro S, Sgouros S, Constantini S, Bock HC : TROPHY registry study design : a prospective, international multicenter study for the surgical treatment of posthemorrhagic hydrocephalus in neonates. Childs Nerv Syst 35 : 613-619, 2019. – reference: 12) Klimo P Jr, Thompson CJ, Baird LC, Flannery AM : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 7 : Antibiotics-impregnated shunt systems versus conventional shunts in children : a systematic review and meta-analysis. J Neurosurg Pediatr (suppl) 14 : 53-59, 2014. – reference: 2) Bauer DF, Baird LC, Klimo P Jr, Mazzola CA, Nikas DC, Tamber MS, Flannery AM : Congress of Neurological Surgeons systematic review and evidence-based guidelines on the treatment of pediatric hydrocephalus : update of the 2014 guidelines. Neurosurgery 87 : 1071-1075, 2020. – reference: 4) 原田敦子 : 小児水頭症に対するVPシャント術 vs. 神経内視鏡手術―現状と課題―. 脳外誌 27 : 646-652, 2018. – reference: 5) 原田敦子 : 小児①水頭症. 吉村紳一監, 吉本幸司編 : 専門医なら知っておきたい疾患・術式別脳神経外科手術合併症の回避・対処法Q & A156. 大阪, メディカ出版, 2019, pp.240-245. – reference: 6) Hayashi T, Shirane R, Yokosawa M, Kimiwada T, Tominaga T : Efficacy of intraoperative irrigation with saline for preventing shunt infection. J Neurosurg Pediatr 6 : 273-276, 2010. – reference: 7) Hsu CH, Chou SC, Yang SH, Shih MC, Kuo MF : Using a burr hole valve prevents proximal shunt failure in infants and toddlers. J Neurosurg Pediatr 24 : 315-322, 2019. – reference: 10) Kestle JRW, Holubkov R, Cochrane DD, Kulkarni AV, Limbrick DD Jr, Luerssen TG, Oakes WJ, Riva-Cambrin J, Rozzelle C, Simon TD, Walker ML, Wellons JC 3rd, Browd SR, Drake JM, Shannon CN, Tamber MS, Whitehead WE ; Hydrocephalus Clinical Research Network : A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr 17 : 391-396, 2016. – reference: 22) Tamber MS, Kestle JRW, Reeder RW, Holubkov R, Alvey J, Browd SR, Drake JM, Kulkarni AV, Limbrick DD, McDonald PJ, Rozzelle CJ, Simon TD, Naftel R, Shannon CN, Wellons JC, Whitehead WE, Riva-Cambrin J ; Hydrocephalus Clinical Research Network : Temporal trends in surgical procedures for pediatric hydrocephalus : an analysis of the Hydrocephalus Clinical Research Network core data project. J Neurosurg Pediatr [Epub ahead of print] . – reference: 14) Limbrick DD Jr, Baird LC, Klimo P Jr, Riva-Cambrin J, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 4 : Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr 14 Suppl : 30-34, 2014. – reference: 20) Simon TD, Kronman MP, Whitlock KB, Gove NE, Mayer-Hamblett N, Browd SR, Cochrane DD, Holubkov R, Kulkarni AV, Langley M, Limbrick DD, Luerssen TG, Oakes WJ, Riva-Cambrin J, Rozzelle C, Shannon C, Tamber M, Wellons JC, Whitehead WE, Kestle JRW : Reinfection after treatment of first cerebrospinal fluid shunt infection : a prospective observational cohort study. J Neurosurg Pediatr 21 : 346-358, 2018. – reference: 21) Tamber MS, Klimo P Jr, Mazzola CA, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 8 : Management of cerebrospinal shunt infection. J Neurosurg Pediatr 14 suppl : 60-71, 2014. – reference: 3) Flannery AM, Duhaime AC, Tamber MS, Kemp J ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 3 : Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement. J Neurosurg Pediatr 14 suppl : 24-29, 2014. – reference: 13) Kulkarni AV, Sgouros S, Constantini S ; IIHS Investigators : International infant hydrocephalus study : initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy and shunt for infant hydrocephalus. Childs Nerv Syst 32 : 1039-1048, 2016. – reference: 16) Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD Jr, Rogido M, Mitchell L, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 2 : Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14 (suppl) : 8-23, 2014. – reference: 17) 宮嶋雅一, 下地一彰, 木村孝興, 新井 一 : 米国ガイドラインに基づいた小児水頭症の標準治療―小児水頭症に対する今日の最善の治療法は何か？―. 脳外誌 26 : 564-573, 2017. – reference: 8) Kemp J, Flannery AM, Tamber MS, Duhaime AC ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 9 : Effect of ventricular catheter entry point and position. J Neurosurg Pediatr 14 suppl : 72-76, 2014. – reference: 19) Schulz M, Bührer C, Pohl-Schickinger A, Haberl H, Thomale UW : Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr 13 : 626-635, 2014. – reference: 9) Kestle JRW, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R ; Hydrocephalus Clinical Research Network : A standardized protocol to reduce cerebrospinal fluid shunt infection : The Hydrocephalus Clinical Research Network quality improvement initiative. J Neurosurg Pediatr 8 : 22-29, 2011. – reference: 15) Mallucci CL, Jenkinson MD, Conroy EJ, Hartley JC, Brown M, Dalton J, Kearns T, Moitt T, Griffiths MJ, Culeddu G, Solomon T, Hughes D, Gamble C ; BASICS Study collaborators : Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS) : a multicentre, single-blinded, randomized trial and economic evaluation. Lancet 394 : 1530-1539, 2019. – reference: 1) Baird LC, Mazzola CA, Auguste KI, Klimo P Jr, Flannery AM : Pediatric hydrocephalus : systemic literature review and evidence-based guidelines. Part 5 : Effect of valve type on cerebrospinal fluid shunt efficacy. J Neurosurg Pediatr 14 (Suppl) : 35-43, 2014. – reference: 11) Klimo P Jr, Van Poppel M, Thompson CJ, Baird LC, Duhaime AC, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 6 : Preoperative antibiotics for shunt surgery in children with hydrocephalus : a systematic review and meta-analysis. J Neurosurg Pediatr 14 (Suppl) : 44-52, 2014. – reference: 18) Nikas DC, Post AF, Choudhri AF, Mazzola CA, Mitchell L, Flannery AM ; Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force : Pediatric hydrocephalus : systematic literature review and evidence-based guidelines. Part 10 : Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr 14 suppl : 77-81, 2014. |
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| Title | 小児水頭症における最良の手術とデバイスの選択 |
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