儿童复杂性脑积水的诊治新策略：阶段性手术管理流程

杨倚剑; 王峻强; 黄军; 张治平; 何剑; 肖格磊

doi:10.11817/j.issn.1672-7347.2026.250328

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论著 | 更新时间：2026-05-05

儿童复杂性脑积水的诊治新策略：阶段性手术管理流程
A novel strategy for the diagnosis and treatment of complex hydrocephalus in children: A staged surgical management protocol
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：277-286
作者机构：

1.中南大学湘雅医院神经外科，长沙 410008
2.中南大学湘雅医院脑积水诊疗中心，长沙 410008
3.中南大学湘雅医院儿科，长沙410008
作者简介：

杨倚剑，Email: yangyijian@csu.edu.cn, ORCID: 0009-0006-3482-3226
肖格磊，副主任医师，Email: xiaogelei@csu.edu.cn, ORCID: 0000-0001-9234-0595
基金信息：

国家自然科学基金(82371362┫。This work was supported by the National Natural Science Foundation of China ┣82371362)
DOI：10.11817/j.issn.1672-7347.2026.250328
中图分类号：
CSTR：
收稿：2025-06-18，

纸质出版：2026-02-28
稿件说明：

杨倚剑, 王峻强, 黄军, 张治平, 何剑, 肖格磊. 儿童复杂性脑积水的诊治新策略：阶段性手术管理流程[J]. 中南大学学报(医学版), 2026, 51(2): 277-286.

YANG Yijian, WANG Junqiang, HUANG Jun, ZHANG Zhiping, HE Jian, XIAO Gelei. A novel strategy for the diagnosis and treatment of complex hydrocephalus in children: A staged surgical management protocol[J]. Journal of Central South University. Medical Science, 2026, 51(2): 277-286.
杨倚剑, 王峻强, 黄军, 张治平, 何剑, 肖格磊. 儿童复杂性脑积水的诊治新策略：阶段性手术管理流程[J]. 中南大学学报(医学版), 2026, 51(2): 277-286. DOI：10.11817/j.issn.1672-7347.2026.250328.

YANG Yijian, WANG Junqiang, HUANG Jun, ZHANG Zhiping, HE Jian, XIAO Gelei. A novel strategy for the diagnosis and treatment of complex hydrocephalus in children: A staged surgical management protocol[J]. Journal of Central South University. Medical Science, 2026, 51(2): 277-286. DOI：10.11817/j.issn.1672-7347.2026.250328.

摘要

目的

儿童复杂性脑积水的诊治策略目前尚不完善，患者常因反复出现并发症而多次进行手术，其疗效较差。本研究旨在建立一种新的手术管理流程，以减少复杂性脑积水患者的手术次数，并改善其长期预后。

方法

回顾性分析2018年6月至2025年6月中南大学湘雅医院脑积水诊疗中心收治的儿童复杂性脑积水患者的临床资料。复杂性脑积水指需多次手术治疗的脑积水，出血后脑积水，感染后脑积水，多房性脑积水，早产低体重儿的先天性脑积水，以及中脑导水管狭窄、Dandy-Walker畸形等其他复杂情况脑积水。其中接受阶段性手术管理流程治疗的患者纳入新策略组，接受原有治疗流程治疗的患者纳入旧策略组。比较2组患者手术治疗情况、短期及长期预后。结合典型病例与国内外文献，制订适用于儿童复杂性脑积水的新诊治策略。

结果

共纳入137例儿童复杂性脑积水患者，其中新策略组49例，旧策略组88例。2组患者在性别、年龄及复杂性因素方面的差异均无统计学意义(均

0.05)。新策略组患者共接受74次手术治疗，旧策略组患者共接受283次手术治疗，

新策略组患者接受手术次数明显少于旧策略组(1.51±0.77 vs 3.22±1.40)，差异有统计学意义(

=7.879，

0.001)。在新策略组中，49例患者的临床症状均得到缓解，35例患者的影像学检查结果显示脑室系统恢复至正常大小；在旧策略组中，82例患者的临床症状得到缓解，53例患者的影像学检查结果显示脑室系统恢复至正常大小。2组在临床症状缓解和脑室系统大小恢复方面的差异均无统计学意义(均

0.05)。在长期预后方面，新策略组中45例认知清晰，42例发育良好，41例功能正常，11例出现并发症，10例需要再次手术，生存率为100%；旧策略组中66例认知清晰，59例发育良好，59例功能正常，80例出现并发症并需要再次手术，生存率为92.05%。2组间各项长期预后指标的差异均有统计学意义(均

0.05)。建立儿童复杂性脑积水诊治新策略——阶段性手术管理流程：在第一阶段消除复杂性因素，第二阶段治疗脑积水。

结论

将早产低体重儿的脑积水、由颅内出血和/或颅内感染引起的脑积水、多房性脑积水和需要反复多次手术的脑积水，以及其他特殊情况脑积水定义为儿童复杂性脑积水。对儿童复杂性脑积水，阶段性手术管理流程不仅可减少手术次数，还可改善患者的长期预后。

Abstract

Objective

Current strategies for the diagnosis and treatment of complex hydrocephalus in children remain inadequate. Patients often undergo multiple surgeries due to recurrent complications

resulting in poor therapeutic outcomes. This study aims to establish a novel surgical management protocol to reduce the number of surgeries and improve long-term prognosis in patients with complex hydrocephalus.

Methods

A retrospective analysis was conducted on the clinical data of pediatric patients with complex hydrocephalus admitted to the Diagnosis and Treatment Center for Hydrocephalus of Xiangya Hospital

Central South University

from June 2018 to June 2025. Complex hydrocephalus was defined as hydrocephalus requiring multiple surgical interventions

post-hemorrhagic hydrocephalus

post-infectious hydrocephalus

multiloculated hydrocephalus

congenital hydrocephalus in preterm low birth weight infants

aqueductal stenosis

Dandy-Walker malformation

and other complex conditions. Patients treated with the staged surgical management protocol were included in the new-strategy group

while those treated with the conventional management protocol were included in the traditional-strategy group. Surgical treatment characteristics

as well as short-term and long-term outcomes

were compared between the two groups. Based on representative cases and a review of the literature

a new diagnostic and therapeutic strategy for pediatric complex hydrocephalus was developed.

Results

A total of 137 pediatric patients with complex hydrocephalus were included

comprising 49 in the new-strategy group and 88 in the traditional-strategy group. There were no statistically significant differences in gender

age

or complexity factors between the two groups (all

0.05). A total of 74 surgical procedures were performed in the new-strategy group and 283 in the traditional-strategy group. The number of surgeries per patient was significantly lower in the new-strategy group than in the traditional-strategy group (1.51±0.77 vs 3.22±1.40;

=7.879

0.001). In the new-strategy group

clinical symptoms were relieved in 49 patients

and ventricular size returned to normal in 35 patients. In the traditional-strategy group

clinical symptoms improved in 82 patients

and ventricular size normalized in 53 patients. There were no statistically significant differences between the two groups in terms of symptom relief or ventricular size recovery (all

0.05). Regarding long-term outcomes

in the new-strategy group

45 patients had clear cognition

42 had good development

41 had normal function

11 developed complications

10 required reoperation

and the survival rate was 100%. In the traditional-strategy group

66 patients had clear cognition

59 had good development

59 had normal function

and 80 developed complications requiring reoperation

with a survival rate of 92.05%. All long-term outcome indicators showed statistically significant differences between the two groups (all

0.05). A novel strategy for the diagnosis and treatment of pediatric complex hydrocephalus

namely

a staged surgical management protocol

was established

consisting of elimination of complexity factors

in the first stage and treatment of hydrocephalus in the second stage.

Conclusion

Hydrocephalus in preterm low birth weight infants

hydrocephalus caused by intracranial hemorrhage and/or infection

multiloculated hydrocephalus

hydrocephalus requiring repeated surgeries

and other special forms should be defined as complex hydrocephalus in children. The staged surgical management protocol not only reduces the number of surgeries but also improves long-term prognosis in pediatric patients with complex hydrocephalus.

关键词

Keywords

references

Yang Y , He J , Wang Y , et al . Targeting choroid plexus epithelium as a novel therapeutic strategy for hydrocephalus [J ] . J Neuroinflammation , 2022 , 19 ( 1 ): 156 . https://doi.org/10. 1186/s12974-022-02500-3 https://doi.org/10.1186/s12974-022-02500-3 .

Karakaya D , Lampe K , Encinas JL , et al . Neurogenesis and glial impairments in congenital hydrocephalus: insights from a BioGlue-induced fetal lamb model [J ] . Fluids Barriers CNS , 2025 , 22 ( 1 ): 20 . https://doi.org/10.1186/s12987-025-00630-3 https://doi.org/10.1186/s12987-025-00630-3 .

Robert SM , Reeves BC , Kiziltug E , et al . The choroid plexus links innate immunity to CSF dysregulation in hydrocephalus [J ] . Cell , 2023 , 186 ( 4 ): 764 - 785.e21 . https://doi.org/10.1016/j.cell.2023.01.017 https://doi.org/10.1016/j.cell.2023.01.017 .

Li Y , Di C , Song S , et al . Choroid plexus mast cells drive tumor-associated hydrocephalus [J ] . Cell , 2023 , 186 ( 26 ): 5719 - 5738.e28 . https://doi.org/10.1016/j.cell.2023.11.001 https://doi.org/10.1016/j.cell.2023.11.001 .

Li Z , Zhang H , Hu G , et al . Post-traumatic hydrocephalus: an overview of classification, diagnosis, treatment, and post-treatment imaging evaluation [J ] . Brain Res Bull , 2023 , 205 : 110824 . https://doi.org/10.1016/j.brainresbull.2023.110824 https://doi.org/10.1016/j.brainresbull.2023.110824 .

Gabbita AC , Raju S . Management of complex hydrocephalus [J ] . Neurol Ind , 2021 , 69 ( Suppl 2 ): S350 - S356 . https://doi.org/10. 4103/0028-3886.332284 https://doi.org/10.4103/0028-3886.332284 .

Kulkarni AV , Sgouros S , Constantini S , et al . International Infant Hydrocephalus Study: initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus [J ] . Child’s Nerv Syst , 2016 , 32 ( 6 ): 1039 - 1048 . https://doi.org/10.1007/s00381-016-3095-1 https://doi.org/10.1007/s00381-016-3095-1 .

Ferris E , Kynaston J , Dalle DU , et al . The etiology of pediatric hydrocephalus across Asia: a systematic review and meta-analysis [J ] . J Neurosurg Pediatr , 2024 , 33 ( 4 ): 323 - 333 . https://doi. org/10.3171/2023.11.peds23389 https://doi.org/10.3171/2023.11.peds23389 .

Zhang Q , Chen Y , Li Y , et al . Neutrophil extracellular trap-mediated impairment of meningeal lymphatic drainage exacerbates secondary hydrocephalus after intraventricular hemorrhage [J ] . Theranostics , 2024 , 14 ( 5 ): 1909 - 1938 . https://doi. org/10.7150/thno.91653 https://doi.org/10.7150/thno.91653 .

Chen J , Wang L , Peng X , et al . Identification of CSPG4 as a biomarker and therapeutic target for infantile post-hemorrhagic hydrocephalus via multi-omics analysis [J ] . Adv Sci , 2025 , 12 ( 6 ): 2410056 . https://doi.org/10.1002/advs.202410056 https://doi.org/10.1002/advs.202410056 .

Sadegh C , Xu H , Sutin J , et al . Choroid plexus-targeted NKCC1 overexpression to treat post-hemorrhagic hydrocephalus [J ] . Neuron , 2023 , 111 ( 10 ): 1591 - 1608 . https://doi. org/10.1016/j.neuron.2023.02.020 https://doi.org/10.1016/j.neuron.2023.02.020 .

Zima LA , Belal AM , Sandberg DI . Choroid plexus cauterization to treat inadequate abdominal cerebrospinal fluid absorption: case report [J ] . Child’s Nerv Syst , 2022 , 38 ( 4 ): 817 - 820 . https://doi.org/10.1007/s00381-021-05298-2 https://doi.org/10.1007/s00381-021-05298-2 .

Khan MB , Riaz M , Enam SA . Endoscopic third ventriculostomy for obstructive hydrocephalus: Outcome analysis of 120 consecutively treated patients from a developing country [J ] . Int J Surg , 2016 , 26 : 69 - 72 . https://doi.org/10.1016/j.ijsu.2015.12.001 https://doi.org/10.1016/j.ijsu.2015.12.001 .

Mansoor N , Gulati S , Fredriksli OA , et al . Epidemiology and practice variations of shunt surgery for hydrocephalus: a nationwide registry-based study [J ] . J Neurosurg , 2023 , 139 ( 3 ): 892 - 900 . https://doi.org/10.3171/2022.12.JNS222083 https://doi.org/10.3171/2022.12.JNS222083 .

Palpan Flores A , Saceda Gutiérrez J , Brin Reyes JR , et al . Risk factors associated with conversion of an Ommaya reservoir to a permanent cerebrospinal fluid shunt in preterm posthemorrhagic hydrocephalus [J ] . J Neurosurg Pediatr , 2020 , 25 ( 4 ): 417 - 424 . https://doi.org/10.3171/2019.11.peds19320 https://doi.org/10.3171/2019.11.peds19320 .

Alojan AA , Alotaibi AR , Alalhareth HN , et al . Management and outcome of post-infectious multiloculated hydrocephalus: a case series [J ] . Saudi J Med Med Sci , 2021 , 9 ( 3 ): 261 - 266 . https://doi.org/10.4103/sjmms.sjmms_85_21 https://doi.org/10.4103/sjmms.sjmms_85_21 .

Lee YH , Kwon YS , Yang KH . Multiloculated hydrocephalus: open craniotomy or endoscopy? [J ] . J Korean Neurosurg Soc , 2017 , 60 ( 3 ): 301 - 305 . https://doi.org/10.3340/jkns.2017.0101.013 https://doi.org/10.3340/jkns.2017.0101.013 .

Aydın E , Duru S , Oria M , et al . Advances in prenatal surgical management of congenital aqueductal stenosis: a bench to bedside approach [J ] . Semin Fetal Neonatal Med , 2024 , 29 ( 2/3 ): 101540 . https://doi.org/10.1016/j.siny.2024.101540 https://doi.org/10.1016/j.siny.2024.101540 .

Ocampo-Navia MI , Perez-Mendez W , Rodriguez-Alvarez MP , et al . Dandy-Walker syndrome: an updated literature review [J ] . Child’s Nerv Syst , 2025 , 41 ( 1 ): 194 . https://doi.org/10. 1007/s00381-025-06842-0 https://doi.org/10.1007/s00381-025-06842-0 .

Gepp R , Lee JH , Parthiban J , et al . Pediatric chiari malformation management: WFNS spine committee recommendations [J/OL ] . Spine , 2025 , 50 ( 11 ): E208 - E212 [ 2025-06-01 ] . https://doi. org/10.1097/brs.0000000000005290 https://doi.org/10.1097/brs.0000000000005290 .

Yang Y , Wang J , Wang K , et al . Complex hydrocephalus in children: procedure of surgical management [J/OL ] . Iran J Pediatr , 2025 , 35 ( 3 ): e 149973 [ 2025-06-01 ] . https://doi.org/10. 5812/ijped-149973 https://doi.org/10.5812/ijped-149973 .

Chen L , He M , Shi L , et al . Effects of modified external ventricular drainage vs. an Ommaya reservoir in the management of hydrocephalus with intracranial infection in pediatric patients [J ] . Front Neurol , 2024 , 14 : 1303631 . https://doi. org/10.3389/fneur.2023.1303631 https://doi.org/10.3389/fneur.2023.1303631 .

Noris A , Giordano F , Peraio S , et al . Loculated hydrocephalus: is neuroendoscopy effective and safe? A 90 patients’ case series and literature review [J ] . Childs Nerv Syst , 2023 , 39 ( 3 ): 711 - 720 . https://doi.org/10.1007/s00381-022-05747-6 https://doi.org/10.1007/s00381-022-05747-6 .

Komori Y , Nonaka M , Iwamura H , et al . The effect of shunt removal on the quality of life in patients with congenital hydrocephalus [J ] . Childs Nerv Syst , 2023 , 39 ( 5 ): 1261 - 1266 . https://doi.org/10.1007/s00381-023-05835-1 https://doi.org/10.1007/s00381-023-05835-1 .

Wang R , Ding Y , Yang M , et al . Diagnosis, management, and neurodevelopmental outcomes of fetal hydrocephalus: an observational prospective study [J ] . Childs Nerv Syst , 2021 , 37 ( 12 ): 3777 - 3784 . https://doi.org/10.1007/s00381-021-05213-9 https://doi.org/10.1007/s00381-021-05213-9 .

Ouyang Q , Wang J , Yang Y , et al . A two-step therapeutic strategy in the management of critical neonatal hydrocephalus [J ] . Turk Neurosurg , 2024 . https://doi.org/10.5137/1019-5149.jtn.47201-24.1 https://doi.org/10.5137/1019-5149.jtn.47201-24.1 .

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