목적 : Ventriculoperitoneal shunt(VPS) operation is a surgical approach for treatment of increased intracranial pressure. There were reports of patients with congenital hydrocephalus who developed bilateral enophthalmos after ventriculoperitoneal shunt. We analyzed orbital volume before and after shunt operation in patients underwent VP shunt.방법 : Orbital volumetric analysis was performed on 30 patients(mean age 58 years, 16 male and 14 female patients) who underwent ventriculoperitoneal shunt with no evidences of orbital fractures or maxillary lesions. ITK-snap(version 2.0 software) was used to analyze orbital CT axial images by measuring the orbital area. The calculated orbital volumes at pre-shunt were compared with post-shunt using the Wilcoxon matched-pairs signed rank test. (GraphPad Software, San Diego,CA).결과 : There was no case of enophthalmos or related symptoms in all patients. The average follow up period was 8.9 months after initial shunt. Pre-shunt mean orbital volume were 23.9cm3(right), and 24.6cm3 (left), which was not statistically significantly different from post-shunt mean 23.6cm3(right),and 24.1cm3(left)(P=0.5959).
However, the orbit volume was significantly increased in 4 patients(8 eyes) who were followed for more than 23 months after shunting when we compared it below 23 months.(P= 0.0156). 결론 : Previously suggested mechanisms for enophthalmos and increased orbital volume was intracranial hypotension-related skull remodeling. In this study, the increased orbital volume can only be observed in patients underwent VPS for more than 23 months. We should consider the possibility of secondary enophthalmos with long term intracranial hypotension. |