PrasatwitthayaDDST = Denver developmental screening test EVD = External ventricular drainage HCP = Hydrocephalus ICP = Increased intracranial pressure IVH = Intraventricular hemorrhage

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

(Clinical Practice Guidelines for Hydrocephalus)

©∫—∫∑’Ë 1 æ.». 2549 (æ‘¡æå§√—Èß∑’Ë 1)

ISBN : 974-422-313-8

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”π’È ‡ªìπ‡§√◊ËÕß¡◊Õ àß‡ √‘¡

§ÿ≥¿“æ¢Õß°“√∫√‘°“√¥â“π ÿ¢¿“æ∑’Ë‡À¡“– ¡°—∫∑√—æ¬“°√·≈–

‡ß◊ËÕπ‰¢ —ß§¡‰∑¬ ‚¥¬À«—ßº≈„π°“√ √â“ß‡ √‘¡·≈–·°â‰¢ªí≠À“

ÿ¢¿“æ¢Õß§π‰∑¬Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ·≈–§ÿâ¡§à“ ¢âÕ·π–π”µà“ß Ê

„π·π«∑“ß°“√√—°…“π’È‰¡à„™à¢âÕ∫—ß§—∫¢Õß°“√ªØ‘∫—µ‘ ºŸâ„™â “¡“√∂

ªØ‘∫—µ‘·µ°µà“ß‰ª®“°¢âÕ·π–π”‰¥â „π°√≥’∑’Ë ∂“π°“√≥å·µ°µà“ß

ÕÕ°‰ªÀ√◊Õ¡’‡Àµÿº≈∑’Ë ¡§«√ ‚¥¬„™â«‘®“√≥≠“≥∑’Ë‡ªìπ∑’Ë¬Õ¡√—∫

„π —ß§¡

§”π‘¬¡

¿“«–‚æ√ß ¡Õß§—ËßπÈ” (hydrocephalus) ‡ªìπ‚√§¢Õß√–∫∫ª√– “∑ à«π°≈“ß (central nervous

system) ∑’Ëæ∫∫àÕ¬„πºŸâªÉ«¬∑ÿ°°≈ÿà¡Õ“¬ÿ ‚¥¬¡’Õÿ∫—µ‘°“√≥å¡“°„π‡¥Á° ¿“«–π’È‡°‘¥®“°°“√ √â“ßπÈ”‰¢ —πÀ≈—ß

¡“°º‘¥ª°µ‘ À√◊Õªî¥°—Èπ∑“ß‡¥‘ππÈ”‰¢ —πÀ≈—ß™—Ë«§√“«À√◊Õ∂“«√ À√◊Õ°“√¥Ÿ¥´÷¡°≈—∫¢ÕßπÈ”‰¢ —πÀ≈—ß

∑“ßÀ≈Õ¥‡≈◊Õ¥¥”º‘¥ª°µ‘ à«π„À≠à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â (secondary hydrocephalus) ‡™àπ ‡π◊ÈÕßÕ°

„π ¡Õß ‡≈◊Õ¥ÕÕ°„π ¡Õß °“√µ‘¥‡™◊ÈÕ„π ¡Õß venous sinus thrombosis ‡ªìπµâπ ¡’‡æ’¬ß à«ππâÕ¬∑’Ë

°“√µ√«®«‘π‘®©—¬∑“ßÀâÕßªØ‘∫—µ‘°“√„πªí®®ÿ∫—π‰¡à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â (idiopathic À√◊Õ primary

hydrocephalus) ‡π◊ËÕß®“°„π·µà≈– ∂“πæ¬“∫“≈¡’§«“¡·µ°µà“ß„π¥â“π∫ÿ§≈“°√·≈–‡§√◊ËÕß¡◊Õ∑’Ë„™â«‘π‘®©—¬

∑“ß°“√·æ∑¬å √«¡∑—Èß°“√°√–®“¬∑’Ë‰¡à‡À¡“– ¡ ®÷ß¡’‡«™ªØ‘∫—µ‘∑’Ë·µ°µà“ß°—π∑—Èß¥â“π°“√«‘π‘®©—¬·≈–°“√∫”∫—¥

√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”

∂“∫—πª√– “∑«‘∑¬“ „π∞“π–‡ªìπ ∂“∫—π«‘™“°“√‡©æ“–∑“ß¥â“π√–∫∫ª√– “∑„π√–¥—∫ Ÿß°«à“µµ‘¬¿Ÿ¡‘

‰¥âµ√–Àπ—°∂÷ßªí≠À“¥—ß°≈à“« ®÷ß‰¥â®—¥∑”·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”„π√–¥—∫ª√–‡∑» ‚¥¬√à«¡°—∫

ºŸâ∑√ß§ÿ≥«ÿ≤‘·≈–ºŸâ‡™’Ë¬«™“≠¥â“π°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”∑—Ë«ª√–‡∑» ‡æ◊ËÕÀ«—ß„Àâ‡°‘¥ª√–‚¬™πå

·°à·æ∑¬å·≈–∫ÿ§≈“°√ºŸâ‡°’Ë¬«¢âÕßÕ¬à“ß·∑â®√‘ß „π°“√∑’Ë®–π”§«“¡√Ÿâ∑’Ë‰¥â√—∫‰ªªØ‘∫—µ‘‰¥â∂Ÿ°µâÕß·≈–‡ªìπ

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2. ®—¥ àß·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” (©∫—∫√à“ß) æ√âÕ¡·∫∫ª√–‡¡‘π„Àâ·æ∑¬å∑—Ë«ª√–‡∑»

‚¥¬ºà“π∑“ß§≥–·æ∑¬»“ µ√å¢Õß¡À“«‘∑¬“≈—¬µà“ß Ê ‚√ßæ¬“∫“≈»Ÿπ¬å ‚√ßæ¬“∫“≈∑—Ë«‰ª ·≈– ”π—°ß“π

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3. ‡™‘≠·æ∑¬å∑—Ë«ª√–‡∑»‡¢â“√à«¡ª√–™ÿ¡/ —¡¡π“ ª√—∫ª√ÿß·π«∑“ßœ (©∫—∫√à“ß) „π«—π∑’Ë 20 - 21

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ªØ‘∫—µ‘‡∑à“π—Èπ ∑—Èßπ’È „π°“√ªØ‘∫—µ‘®√‘ß¢÷Èπ°—∫¥ÿ≈¬æ‘π‘®¢Õß·æ∑¬åºŸâ¥Ÿ·≈ºŸâªÉ«¬¢≥–π—Èπ‡ªìπ ”§—≠

„π∑â“¬∑’Ë ÿ¥π’È ∂“∫—πª√– “∑«‘∑¬“À«—ß‡ªìπÕ¬à“ß¬‘Ëß«à“ ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”

©∫—∫π’È ®—°‡°‘¥ª√–‚¬™πå ”À√—∫·æ∑¬å∑’Ë®–π”‰ªª√–¬ÿ°µå„™â ‡æ◊ËÕ„Àâª√–™“™π¡’§ÿ≥¿“æ™’«‘µ∑’Ë¥’ „π‚Õ°“ π’È

„§√à¢Õ¢Õ∫§ÿ≥ √“™«‘∑¬“≈—¬°ÿ¡“√·æ∑¬å·Ààßª√–‡∑»‰∑¬ ¡“§¡ª√– “∑»—≈¬»“ µ√å ·Ààßª√–‡∑»‰∑¬

¡“§¡°ÿ¡“√·æ∑¬å·Ààßª√–‡∑»‰∑¬ °√¡·æ∑¬å∑À“√∫° §≥–·æ∑¬»“ µ√å®“°¡À“«‘∑¬“≈—¬µà“ß Ê ∑’Ë‰¥â

„Àâ§«“¡√à«¡¡◊ÕÕ¬à“ß¥’„π°“√®—¥∑” √«¡∑—Èß°√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ∑’Ë π—∫ πÿπ°“√¥”‡π‘πß“π§√—Èßπ’È

Õ¬à“ß¥’¬‘Ëß

(π“¬¡—¬∏—™ “¡‡ π)

ºŸâÕ”π«¬°“√ ∂“∫—πª√– “∑«‘∑¬“

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§≥–ºŸâ®—¥∑”

1. πæ. ¡“π µ—ÈßÕ√ÿ≥»‘≈ªá ª√–∏“π ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

2. √». πæ.Õπ—πµåπ‘µ¬å «‘ ÿ∑∏‘æ—π∏åÿ √“™«‘∑¬“≈—¬°ÿ¡“√·æ∑¬å·Ààßª√–‡∑»‰∑¬

3. πæ.™àÕ‡æ’¬« ‡µ‚™Ã“√ ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààßª√–‡∑»‰∑¬

4. º». πæ.‡Õ° À—ß Ÿµ §≥–·æ∑¬»“ µ√å ‚√ßæ¬“∫“≈√“¡“∏‘∫¥’

5. æ.Õ. πæ. ‘√√ÿ®πå °ÿ≈≥–¡√√§“ ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààßª√–‡∑»‰∑¬

6. πæ. ¡®‘µ »√’Õÿ¥¡¢®√ ∂“∫—π ÿ¢¿“æ‡¥Á°·Ààß™“µ‘¡À“√“™‘π’ °√¡°“√·æ∑¬å

7. πæ.«‘∫Ÿ≈¬å °“≠®πæ—≤π°ÿ≈ ∂“∫—π ÿ¢¿“æ‡¥Á°·Ààß™“µ‘¡À“√“™‘π’ °√¡°“√·æ∑¬å

8. πæ.¿“≥ÿ π“®√ÿß ∂“∫—π ÿ¢¿“æ‡¥Á°·Ààß™“µ‘¡À“√“™‘π’ °√¡°“√·æ∑¬å

9. πæ.æ‘™‘µ Õπÿ«ÿ≤‘π“«‘π ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

10. æ≠.°—≈¬“≥å ∏’√–«‘∫Ÿ≈¬å ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

11. πæ.æ‘‡™…∞ ‡¡∏“√—°…å™’æ ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

12. æ≠.Õ“¿“»√’ ≈ÿ «— ¥‘Ï ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

13. πæ.°ÿ≈æ—≤πå «’√ “√ ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

14. πæ.∏’√™—¬ º“≥‘µæß»å ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

15. πæ. ÿ√»—°¥‘Ï ‚°¡≈®—π∑√å ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

16. π. .Õ‘ √’ µ√’°¡≈ ‡≈¢“πÿ°“√ ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

∫√√≥“∏‘°“√ : πæ. ¡“π µ—ÈßÕ√ÿ≥»‘≈ªá

�

§≥–∑”ß“π‚§√ß°“√®—¥∑”·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”

∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

1. πæ. ÿ√«‘∑¬å ‡µ™∏ÿ«“ππ∑å ∑’Ëª√÷°…“

2. πæ.¡—¬∏—™ “¡‡ π ∑’Ëª√÷°…“

3. æ≈.Õ.µ. πæ.§”æ√ ™“≠«‘‡»… ∑’Ëª√÷°…“

4. πæ.æ‘™‘µ Õπÿ«ÿ≤‘π“«‘π ∑’Ëª√÷°…“

5. æ≠.°—≈¬“≥å ∏’√–«‘∫Ÿ≈¬å ∑’Ëª√÷°…“

6. πæ.Õ—¡æ√ ®ß‡ √’®‘µµå ∑’Ëª√÷°…“

7. πæ. ¡“π µ—ÈßÕ√ÿ≥»‘≈ªá ª√–∏“π

8. √». æ≠.®‘√æ√ ‡À≈à“∏√√¡∑—»πå §≥–∑”ß“π

9. πæ.™àÕ‡æ’¬« ‡µ‚™Ã“√ §≥–∑”ß“π

10. πæ.Õπ—πµåπ‘µ¬å «‘ ÿ∑∏‘æ—π∏ÿå §≥–∑”ß“π

11. º». πæ.‡Õ° À—ß Ÿµ §≥–∑”ß“π

12. æ.Õ. πæ. ‘√√ÿ®πå °ÿ≈≥–¡√√§“ §≥–∑”ß“π

13. πæ.™“§√‘π∑√å ≥ ∫“ß™â“ß §≥–∑”ß“π

14. πæ. ¡®‘µ »√’Õÿ¥¡¢®√ §≥–∑”ß“π

15. πæ.¿“≥ÿ π“®√ÿß §≥–∑”ß“π

16. πæ.æ‘‡™…∞ ‡¡∏“√—°…å™’æ §≥–∑”ß“π

17. æ≠.Õ“¿“»√’ ≈ÿ «— ¥‘Ï §≥–∑”ß“π

18. πæ.°ÿ≈æ—≤πå «’√ “√ §≥–∑”ß“π

19. πæ.∏’√™—¬ º“≥‘µæß»å ‡≈¢“πÿ°“√

20. π. .Õ‘ √’ µ√’°¡≈ ºŸâ™à«¬‡≈¢“πÿ°“√

�

§”π”

¿“«–‚æ√ß ¡Õß§—ËßπÈ” (Hydrocephalus) æ∫‰¥â°—∫ºŸâªÉ«¬∑ÿ°°≈ÿà¡Õ“¬ÿ à«π„À≠à¡’ “‡Àµÿ´÷Ëßµ√«®

æ∫‰¥â ¡’‡æ’¬ß à«ππâÕ¬∑’Ë°“√µ√«®«‘π‘®©—¬∑“ßÀâÕßªØ‘∫—µ‘°“√„πªí®®ÿ∫—π‰¡à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â ¿“«–π’È

¬—ß¡’ªí≠À“„π¥â“π°“√µ√«®«‘π‘®©—¬ ·≈–°“√¥Ÿ·≈√—°…“ ¥—ßπ—Èπ ∂“∫—πª√– “∑«‘∑¬“ „π∞“π–∑’Ë‡ªìπ ∂“∫—π

‡©æ“–∑“ß‚√§√–∫∫ª√– “∑ ®÷ß‰¥â√à«¡°—∫§≥–·æ∑¬åºŸâ‡™’Ë¬«™“≠®“°√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààßª√–‡∑»‰∑¬

√“™«‘∑¬“≈—¬°ÿ¡“√·æ∑¬å·Ààßª√–‡∑»‰∑¬ ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààßª√–‡∑»‰∑¬ ¡“§¡°ÿ¡“√·æ∑¬å

·Ààßª√–‡∑»‰∑¬ °√¡·æ∑¬å∑À“√∫° ·≈–§≥–·æ∑¬»“ µ√å®“°¡À“«‘∑¬“≈—¬µà“ß Ê ®—¥∑”·π«∑“ß°“√√—°…“

¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å ‡æ◊ËÕπ”‰ªªØ‘∫—µ‘‡ªìπ·π«∑“ß‡¥’¬«°—π ™à«¬„π°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬Õ¬à“ß¡’

ª√– ‘∑∏‘¿“æ ·≈– “¡“√∂π”‰ªª√—∫„™â„Àâ‡À¡“– ¡°—∫·µà≈–‚√ßæ¬“∫“≈

§≥–ºŸâ®—¥∑”

°√°Æ“§¡ 2549

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“√∫—≠

Àπâ“

§”π‘¬¡

√“¬π“¡§≥–ºŸâ®—¥∑”

√“¬π“¡§≥–∑”ß“π

§”π”

∫∑π” 1

∫∑∑’Ë 1 ·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ” 3

(Management of patients suspected of hydrocephalus)

∫∑∑’Ë 2 ·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”√à«¡°—∫ 5

§«“¡¥—π„π°–‚À≈°»’√…– Ÿß

(Management of patients suspected of HCP with increased intracranial pressure)

∫∑∑’Ë 3 ·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°‡°‘¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß 12

·≈– ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Management of preterm babies suspected of hydrocephalus)

∫∑∑’Ë 4 ·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°·√°§≈Õ¥∑’Ë¡’ myelomeningocele/encephalomeningocele 14

(Management of newborn infants with myelomeningocele/encephalomeningocele)

∫∑∑’Ë 5 ·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë ß —¬‡ªìπ normal pressure hydrocephalus 17

(Management of elderly patients suspected of normal pressure hydrocephalus)

‡Õ° “√Õâ“ßÕ‘ß 20

¿“§ºπ«°

1. Õ“°“√· ¥ß¢Õß¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß„π‡¥Á°‡≈Á° 22

(Signs of increased intracranial pressure in infants)

2. ¿“æ∂à“¬∑“ß√—ß ’„πºŸâªÉ«¬ normal pressure hydrocephalus 28

(MR Imaging of normal pressure hydrocephalus)

3. CSF diversion 32

4. ·∫∫∑¥ Õ∫æ—≤π“°“√ (Denver II) ©∫—∫¿“…“‰∑¬ 34

“√∫—≠·ºπ¿Ÿ¡‘

Àπâ“

·ºπ¿Ÿ¡‘∑’Ë 1 3

°“√®”·π°ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Categorization of patients suspected of hydrocephalus)

·ºπ¿Ÿ¡‘∑’Ë 2 6

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”√à«¡°—∫§«“¡¥—π„π°–‚À≈°

»’√…– Ÿß


·ºπ¿Ÿ¡‘∑’Ë 2.1 7

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”®“°°“√Õÿ¥µ—π¢Õß√–∫∫‚æ√ß ¡Õß

(Management of patients with hydrocephalus from ventricular obstruction)

·ºπ¿Ÿ¡‘∑’Ë 2.2 8

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”®“°°“√Õÿ¥µ—ππÈ”‰¢ —πÀ≈—ß

∑’Ëµ”·Àπàß foramen of Monro

(Management of patients with hydrocephalus from obstruction at foramen of Monro)

·ºπ¿Ÿ¡‘∑’Ë 2.3 10


∑’Ëµ”·ÀπàßµË”°«à“ third ventricle

(Management of patients with hydrocephalus from obstruction distal to third ventricle)

·ºπ¿Ÿ¡‘∑’Ë 3 13

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°§≈Õ¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß ·≈– ß —¬

¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Management of preterm baby with intraventricular hemorrhage suspected of hydrocephalus)

·ºπ¿Ÿ¡‘∑’Ë 4 16

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°·√°§≈Õ¥∑’Ë¡’ myelomeningocele À√◊Õ encephalomeningocele

(Management of newborn with myelomeningocele or encephalomeningocele)

·ºπ¿Ÿ¡‘∑’Ë 5 19

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë ß —¬‡ªìπ normal pressure hydrocephalus

(Management of elderly patient suspected of normal pressure hydrocephalus)

“√∫—≠√Ÿª¿“æ

Àπâ“

√Ÿª∑’Ë 1 Tensed and bulged anterior fontanelle 22

√Ÿª∑’Ë 2 Dilated scalp vein 22

√Ÿª∑’Ë 3 °“√µ√«®¥â«¬«‘∏’ transillumination ‚¥¬„™â‰ø©“¬ àÕß∑’Ë anterior fontanel 23

√Ÿª∑’Ë 4 Transillumination test 23

√Ÿª∑’Ë 5 Fronto-ethmoidal encephalomeningocele 24

√Ÿª∑’Ë 6 Myelomeningocele 24

√Ÿª∑’Ë 7 Ultrasound of hydrocephalus 25

√Ÿª∑’Ë 8 MRI of intraventricular tumor 25

√Ÿª∑’Ë 9 MRI of Chiari malformation 25

√Ÿª∑’Ë 10 ·ºπ¿Ÿ¡‘· ¥ß§à“ª°µ‘¢Õß°“√‡®√‘≠‡µ‘∫‚µ¢Õß∑“√°∑’Ë§≈Õ¥°àÕπ°”Àπ¥®π∂÷ßÕ“¬ÿ 1 ªï 26

√Ÿª∑’Ë 11 ·ºπ¿Ÿ¡‘· ¥ß§à“‡ âπ√Õ∫«ß»’√…– (occipito-frontal circumference; OFC) 27

„π‡¥Á°Õ“¬ÿµ—Èß·µà·√°‡°‘¥∂÷ß 3 ªï

√Ÿª∑’Ë 12 Axial T2W MR shows ventriculomegaly. 28

√Ÿª∑’Ë 13 Sagittal T1W MR shows aqueductal flow void sign. 28

√Ÿª∑’Ë 14 T2W MR shows enlarged ventricles with rounded frontal horns. 28

√Ÿª∑’Ë 15 Axial FLAIR MR shows ventriculomegaly out of proportion to sulcal enlargement. 28

√Ÿª∑’Ë 16 Axial CT scan with contrast media shows symmetrical dilatation of ventricles 28

out of proportion to sulcal enlargement.

√Ÿª∑’Ë 17 Axial CT scan with contrast media shows frontal and occipital periventricular 28

hypodensities suggest transependymal CSF flow.

√Ÿª∑’Ë 18 Proton MR spectra (TR/TE, 2000/135) in the patient with NPH. 29

√Ÿª∑’Ë 19 Proton MR spectra (TR/TE, 2000/135) in two patients with NPH. 30

√Ÿª∑’Ë 20 Proton MR spectra (TR/TE, 2000/135) before and after continuous spinal drainage 31

µ—«¬àÕ

CNS = Central nervous system

CSF = Cerebrospinal fluid

CT = Computerized tomography

DDST = Denver developmental screening test

EVD = External ventricular drainage

HCP = Hydrocephalus

ICP = Increased intracranial pressure

IVH = Intraventricular hemorrhage

LP = Lumbar puncture

MRI = Magnetic resonance imaging

MRS = Magnetic resonance spectroscopy

MRV = Magnetic resonance venography

NPH = Normal pressure hydrocephalus

PHH = Post hemorrhagic hydrocephalus

US = Ultrasound

∫∑π”

¿“«–‚æ√ß ¡Õß§—ËßπÈ” (hydrocephalus) ‡ªìπ‚√§¢Õß√–∫∫ª√– “∑ à«π°≈“ß (central nervous

system) ‡ªìπ¿“«–∑’Ëæ∫∫àÕ¬„πºŸâªÉ«¬∑ÿ°°≈ÿà¡Õ“¬ÿ1 ‚¥¬¡’Õÿ∫—µ‘°“√≥å¡“°„π‡¥Á°2, 3 ¿“«–π’È‡°‘¥®“°°“√ √â“ß

πÈ”‰¢ —πÀ≈—ß¡“°º‘¥ª°µ‘À√◊Õªî¥°—Èπ∑“ß‡¥‘ππÈ”‰¢ —πÀ≈—ß™—Ë«§√“«À√◊Õ∂“«√ À√◊Õ°“√¥Ÿ¥´÷¡°≈—∫¢ÕßπÈ”‰¢ —πÀ≈—ß

∑“ßÀ≈Õ¥‡≈◊Õ¥¥”º‘¥ª°µ‘ à«π„À≠à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â (secondary hydrocephalus) ‡™àπ ‡π◊ÈÕßÕ°

„π ¡Õß ‡≈◊Õ¥ÕÕ°„π ¡Õß °“√µ‘¥‡™◊ÈÕ„π ¡Õß venous sinus thrombosis ‡ªìπµâπ ¡’‡æ’¬ß à«ππâÕ¬∑’Ë°“√µ√«®

«‘π‘®©—¬∑“ßÀâÕßªØ‘∫—µ‘°“√„πªí®®ÿ∫—π‰¡à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â (idiopathic À√◊Õ primary hydrocephalus)

‡π◊ËÕß®“°„π·µà≈– ∂“πæ¬“∫“≈¡’§«“¡·µ°µà“ß„π¥â“π∫ÿ§≈“°√·≈–‡§√◊ËÕß¡◊Õ∑’Ë„™â«‘π‘®©—¬∑“ß°“√·æ∑¬å

√«¡∑—Èß°“√°√–®“¬∑’Ë‰¡à‡À¡“– ¡ ®÷ß¡’‡«™ªØ‘∫—µ‘‰¡à‡À¡◊Õπ°—π∑—Èß¥â“π°“√«‘π‘®©—¬·≈–°“√∫”∫—¥√—°…“¿“«–

‚æ√ß ¡Õß§—ËßπÈ” ‚¥¬‡©æ“–„π‡¥Á°§≈Õ¥°àÕπ°”Àπ¥ (preterm baby) ‡¥Á°∑’Ë‡ªìπ myelomeningocele À√◊Õ

„πºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë‡ªìπ normal pressure hydrocephalus ¥—ßπ—Èπ°“√®—¥∑”·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”

®÷ß‡ªìπ·π«∑“ß™à«¬„Àâ·æ∑¬å “¡“√∂π”‰ªªØ‘∫—µ‘À√◊Õæ‘®“√≥“ àßµàÕºŸâªÉ«¬‰¥âÕ¬à“ß‡À¡“– ¡ µ“¡»—°¬¿“æ

¢Õß·µà≈– ∂“πæ¬“∫“≈ ∑—Ë«ª√–‡∑»

Õπ÷Ëß·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”©∫—∫π’È ¡‘‰¥â¡’‡®µπ“„Àâ·æ∑¬åºŸâªØ‘∫—µ‘π”‰ª‡ªìπ

·π«∑“ß„π°“√√—°…“¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß®“° “‡ÀµÿÕ◊Ëπ Ê ‡™àπ ¿“«–µ‘¥‡™◊ÈÕ„π ¡Õß

‚√§À≈Õ¥‡≈◊Õ¥ ¡ÕßÀ√◊Õ∫“¥‡®Á∫∑’Ë»’√…– ‡ªìπµâπ ·¡â«à“„π¿“«–‡À≈à“π’ÈºŸâªÉ«¬Õ“®®–¡’Õ“°“√·≈–Õ“°“√· ¥ß

¢Õß§«“¡¥—π„π°–‚À≈°»’√…– Ÿß√à«¡¥â«¬

°“√®—¥∑”·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” Õ“»—¬À≈—°∞“π∑“ß«‘™“°“√∑’Ë‰¥âµ’æ‘¡æå·≈â«

‚¥¬·∫àß√–¥—∫§”·π–π”Õ‘ß§ÿ≥¿“æ¢ÕßÀ≈—°∞“π (strength of recommendation) ‡ªìπ 3 √–¥—∫ §◊Õ A, B, C

(µ“√“ß∑’Ë 1) ‡π◊ÈÕÀ“¢Õß·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”©∫—∫π’Èª√–°Õ∫¥â«¬ ·ºπ¿Ÿ¡‘ §”Õ∏‘∫“¬ ‡Õ° “√

Õâ“ßÕ‘ß µ“√“ß ·≈–¿“§ºπ«°

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 1

µ“√“ß∑’Ë 1

√–¥—∫§”·π–π”Õ‘ß§ÿ≥¿“æ (Strength of Recommendation) µ“¡À≈—°∞“π∑“ß«‘™“°“√

À¡“¬‡Àµ ÿ recommendation A π‘¬¡„™â‡ªìπ¡“µ√∞“π„π°“√ªØ‘∫—µ‘„π ∂“π∑’Ë∑’Ë¡’§«“¡æ√âÕ¡

recommendation B ·π–π”„Àâ„™â‡ªìπ·π«∑“ß„π°“√ªØ‘∫—µ‘·µà‰¡à„™à¡“µ√∞“π

recommendation C ·π–π”„Àâ„™â‡ªìπ∑“ß‡≈◊Õ°„π°“√ªØ‘∫—µ‘ ¢÷ÈπÕ¬Ÿà°—∫¥ÿ≈¬æ‘π‘®¢ÕßºŸâ√—°…“

Grade Recommendation

A supported by data from randomized control trials with low false-positive and low

false-negative errors

B supported by data from randomized control trials with high false-positive and high

false-negative errors

C supported by data from non-randomized cohort studies, case series, case report, expert

opinion or consensus

2 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

∫∑∑’Ë 1

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Management of patients suspected of hydrocephalus)

¿“«–‚æ√ß ¡Õß§—ËßπÈ” (hydrocephalus) ‡ªìπ¿“«–∑’Ëæ∫‰¥â„πºŸâªÉ«¬∑ÿ°°≈ÿà¡Õ“¬ÿ1 ‚¥¬¡’Õÿ∫—µ‘°“√≥å Ÿß

„π‡¥Á°2, 3 ¿“«–π’È‡°‘¥®“°°“√ √â“ßπÈ”‰¢ —πÀ≈—ß¡“°º‘¥ª°µ‘ À√◊Õ °“√Õÿ¥µ—π¢Õß∑“ß‡¥‘ππÈ”‰¢ —πÀ≈—ß À√◊Õ

§«“¡º‘¥ª°µ‘¢Õß°“√¥Ÿ¥´÷¡°≈—∫¢ÕßπÈ”‰¢ —πÀ≈—ß∑“ßÀ≈Õ¥‡≈◊Õ¥¥” à«π„À≠à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â

(secondary hydrocephalus) ‡™àπ ‡π◊ÈÕßÕ°„π ¡Õß ‡≈◊Õ¥ÕÕ°„π ¡Õß °“√µ‘¥‡™◊ÈÕ„π ¡Õß venous sinus thrombosis

‡ªìπµâπ ¡’‡æ’¬ß à«ππâÕ¬∑’Ë°“√µ√«®«‘π‘®©—¬∑“ßÀâÕßªØ‘∫—µ‘°“√„πªí®®ÿ∫—π‰¡à “¡“√∂µ√«®æ∫ “‡Àµÿ‰¥â (idiopathic

À√◊Õ primary hydrocephalus) ¥—ßπ—Èπ‡æ◊ËÕ„Àâ°“√«‘π‘®©—¬·≈–°“√∫”∫—¥√—°…“ºŸâªÉ«¬‰¥â –¥«°¢÷Èπ ®÷ß®”·π°

ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ” ÕÕ°‡ªìπ 4 ª√–‡¿∑ ¥—ß·ºπ¿Ÿ¡‘∑’Ë 1

·ºπ¿Ÿ¡‘∑’Ë 1

°“√®”·π°ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Categorization of patients suspected of hydrocephalus)

NB : ICP = Intracranial pressure

NPH = Normal pressure hydrocephalus

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 3

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 1

ºŸâªÉ«¬∑’Ë ß —¬¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ” “¡“√∂·∫àßÕÕ°‰¥â‡ªìπ 4 °≈ÿà¡ ¥—ßπ’È

1. ºŸâªÉ«¬∑’Ë¡’Õ“°“√·≈–Õ“°“√· ¥ß¢Õß§«“¡¥—π„π°–‚À≈°»’√…– Ÿß (symptoms & signs of

increased intracranial pressure) ´÷Ëß¡’§«“¡·µ°µà“ß°—π„π·µà≈–°≈ÿà¡Õ“¬ÿ §◊Õ

1.1 ºŸâªÉ«¬‡¥Á°‡≈Á°∑’Ë anterior fontanel ¬—ß‰¡àªî¥ Õ“®¡’Õ“°“√ tensed and bulged anterior fontanel,

separation of skull suture, cracked pot sound of skull (Macewenûs sign), sunset eyes,

positive transillumination test, accelerated head growth (¿“§ºπ«°∑’Ë 1)

1.2 ºŸâªÉ«¬‡¥Á°‚µ·≈–ºŸâ„À≠à Õ“®¡’Õ“°“√ progressive headache & vomiting, dilated scalp veins,

acquired lateral rectus palsy, hyper-reflexia, papilledema, alteration of consciousness

1.3 ºŸâªÉ«¬‡¥Á°∑’Ë‡ªìπ macrocephaly (head circumference ¡“°°«à“ 98 percentile4) æ∫«à“¡’¿“«–

‚æ√ß ¡Õß§—ËßπÈ”√à«¡¥â«¬√âÕ¬≈– 32 - 854, 5 ©–π—Èπ ∂â“¡’Õ“°“√·≈–Õ“°“√· ¥ß§«“¡¥—π

„π°–‚À≈°»’√…– ŸßµâÕß ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

ºŸâªÉ«¬∑’Ë¡’Õ“°“√·≈–Õ“°“√· ¥ß¥—ß°≈à“«¢â“ßµâπ„Àâæ‘®“√≥“·π«∑“ß°“√√—°…“µ“¡·ºπ¿Ÿ¡‘∑’Ë 2

2. ºŸâªÉ«¬‡¥Á°∑’Ë§≈Õ¥°àÕπ°”Àπ¥ (Õ“¬ÿ§√√¿åπâÕ¬°«à“ 37 —ª¥“Àå) „Àâæ‘®“√≥“·π«∑“ß°“√√—°…“

µ“¡·ºπ¿Ÿ¡‘∑’Ë 3

3. ºŸâªÉ«¬‡¥Á°·√°‡°‘¥∑’Ë‡ªìπ myelomeningocele & encephalomeningocele „Àâæ‘®“√≥“·π«∑“ß°“√

√—°…“µ“¡·ºπ¿Ÿ¡‘∑’Ë 4

4. ºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë ß —¬«à“‡ªìπ normal pressure hydrocephalus (NPH) ´÷Ëß¡’Õ“°“√ ”§—≠ ‰¥â·°à

gait disturbance, dementia and urinary incontinence „Àâæ‘®“√≥“·π«∑“ß°“√√—°…“µ“¡·ºπ¿Ÿ¡‘∑’Ë 5

4 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

∫∑∑’Ë 2

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”√à«¡°—∫§«“¡¥—π„π°–‚À≈°»’√…– Ÿß


ºŸâªÉ«¬∑’Ë¡’¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿßæ∫‰¥â∑—Èß„π‡¥Á°·≈–ºŸâ„À≠à ´÷Ëß‡°‘¥®“° “‡Àµÿµà“ß Ê °—π

‡™àπ ‡π◊ÈÕßÕ°„π ¡Õß (brain tumors) °“√µ‘¥‡™◊ÈÕ„π ¡Õß (CNS infection) ¡Õß∫«¡ (brain edema) ¿“«–

‚æ√ß ¡Õß§—ËßπÈ” (hydrocephalus) ‡ªìπµâπ ¥—ßπ—Èπ ºŸâªÉ«¬∑’Ë¡’Õ“°“√·≈–Õ“°“√· ¥ß¢Õß¿“«–§«“¡¥—π„π

°–‚À≈°»’√…– Ÿß¥—ß‰¥â°≈à“«‰«â„π∫∑∑’Ë 1 ®÷ß§«√µ√«®À“ “‡Àµÿ‡æ◊ËÕ„Àâ°“√«‘π‘®©—¬·≈–√—°…“∑’Ë∂Ÿ°µâÕß

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 2

ºŸâªÉ«¬∑’Ë¡’¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß (increased ICP) §«√ àßµ√«® CT À√◊Õ MRI brain without

or with contrast media („π°√≥’ ß —¬ secondary HCP) „πºŸâªÉ«¬‡¥Á°∑’Ë anterior fontanel ¬—ß‰¡àªî¥ “¡“√∂

æ‘®“√≥“∑” cranial ultrasound ‰¥âµ“¡§«“¡‡À¡“– ¡ (·æ∑¬åºŸâ∑”°“√µ√«®§«√¡’§«“¡™”π“≠) ∂â“º≈°“√µ√«®

‰¡àæ∫¢π“¥¢Õß‚æ√ß ¡Õß‚µº‘¥ª°µ‘ · ¥ß«à“ ¿“«–§«“¡¥—π„π°–‚À≈°»’√…– ŸßÕ“®‡°‘¥®“° “‡Àµÿ

Õ◊Ëπ Ê ‡™àπ space occupying lesion, pseudotumor cerebri, cryptococcal meningitis ‡ªìπµâπ „Àâ√—°…“µ“¡

“‡Àµÿπ—Èπ Ê

∂â“æ∫¢π“¥¢Õß‚æ√ß ¡Õß‚µº‘¥ª°µ‘ „Àâ·¬°«à“‡ªìπ°“√Õÿ¥µ—π¢Õß√–∫∫‚æ√ß ¡Õß (ventri-

cular obstruction) À√◊Õ¿“¬πÕ°√–∫∫‚æ√ß ¡Õß (extraventricular obstruction)* °√≥’‡ªìπ°“√

Õÿ¥µ—π¢Õß√–∫∫‚æ√ß ¡Õß„Àâæ‘®“√≥“·π«∑“ß°“√√—°…“µ“¡·ºπ¿Ÿ¡‘∑’Ë 2.1, 2.2, 2.3

°√≥’‡ªìπ°“√Õÿ¥µ—π¿“¬πÕ°√–∫∫‚æ√ß ¡Õß (extraventricular obstruction) ∂â“æ∫ “‡ÀµÿÀ≈—ß®“°

°“√µ√«®∑“ß√—ß ’ ‡™àπ venous sinus occlusion À√◊Õ leptomeningeal enhancement „Àâ√—°…“µ“¡ “‡Àµÿ

π—Èπ Ê √à«¡°—∫æ‘®“√≥“∑” CSF diversion

∂â“‰¡àæ∫ “‡ÀµÿÀ≈—ß®“°°“√µ√«®∑“ß√—ß ’ „Àâ∑”°“√µ√«® CSF ‡æ◊ËÕæ‘ Ÿ®πå«à“¡’°“√µ‘¥‡™◊ÈÕ„π

CSF À√◊Õ‡´≈≈å¡–‡√Áß„π CSF ´÷Ëß‡ªìπ “‡Àµÿ¢Õß HCP „Àâ∑”°“√√—°…“µ“¡ “‡Àµÿπ—Èπ Ê ·≈–∂â“®”‡ªìπÕ“®

æ‘®“√≥“∑” CSF diversion √à«¡¥â«¬

À“°º≈µ√«®πÈ”‰¢ —πÀ≈—ßª°µ‘ „Àâ∑” CSF diversion ·µà∂â“¬—ß ß —¬«à“ “‡Àµÿ¢Õß HCP

‡°‘¥®“°‚√§À≈Õ¥‡≈◊Õ¥¥”Õÿ¥µ—πÕ“®æ‘®“√≥“∑”°“√µ√«®‡æ‘Ë¡‡µ‘¡ ‡™àπ MRV ‡ªìπµâπ À“°‰¡àæ∫ “‡Àµÿ®÷ßæ‘®“√≥“

∑” CSF diversion

À¡“¬‡Àµÿ *°“√Õÿ¥µ—π¿“¬πÕ°√–∫∫‚æ√ß ¡Õß (extraventricular obstruction) À¡“¬∂÷ß °“√Õÿ¥µ—π¢Õß∑“ß‡¥‘π

CSF ∑’Ë√–¥—∫ leptomeninges, arachnoid granulation, venous system ‚¥¬ª√“»®“° mass lesion

∑’Ë°¥‡∫’¬¥√–∫∫‚æ√ß ¡Õß

2

1

3

6

4

5

7

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 5

·ºπ¿Ÿ¡‘∑’Ë 2

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”√à«¡°—∫§«“¡¥—π„π°–‚À≈°»’√…– Ÿß


* „π ∂“π∑’Ë∑’Ë “¡“√∂µ√«®‰¥â

** „π°√≥’∑’Ë ventricle ¢π“¥ª°µ‘ · ¥ß«à“ ¿“«– increased ICP Õ“®‡°‘¥®“° “‡ÀµÿÕ◊Ëπ ‡™àπ space

occupying lesion, pseudotumor cerebri, cryptococcal meningitis ‡ªìπµâπ

*** „π°√≥’∑’Ë ß —¬ venous sinus obstruction Õ“®æ‘®“√≥“µ√«®‡æ‘Ë¡‡µ‘¡ ‡™àπ MRV ‡ªìπµâπ

a ¥Ÿ„π§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘

6 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

·ºπ¿Ÿ¡‘∑’Ë 2.1

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”®“°°“√Õÿ¥µ—π¢Õß√–∫∫‚æ√ß ¡Õß

(Management of patients with hydrocephalus from ventricular obstruction)

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 2.1

‡¡◊ËÕµ√«®æ∫ ventricular obstruction „Àâ·¬°«à“

1. ¡’ dilatation ¢Õß lateral ventricle ¢â“ß‡¥’¬« (monoventricular HCP) ¥Ÿ·ºπ¿Ÿ¡‘∑’Ë 2.2

2. ¡’ dilatation ¢Õß lateral ventricle ∑—Èß 2 ¢â“ß (biventricular HCP) ¥Ÿ·ºπ¿Ÿ¡‘∑’Ë 2.2

3. ¡’ dilatation ¢Õß∑—Èß 3 ventricles (triventricular HCP) ¥Ÿ·ºπ¿Ÿ¡‘∑’Ë 2.3

4. ¡’ dilatation ¢Õß∑—Èß 4 ventricles (panventricular HCP) ¥Ÿ·ºπ¿Ÿ¡‘∑’Ë 2.3

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 7

·ºπ¿Ÿ¡‘∑’Ë 2.2


∑’Ëµ”·Àπàß foramen of Monro

(Management of patients with hydrocephalus from obstruction at foramen of Monro)

* „π°√≥’∑’Ë ß —¬«à“¬—ß¡’ active purulent meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“ infection

„ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent CSF diversion

8 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 2.2

‡¡◊ËÕµ√«®æ∫ dilatation of lateral ventricle ·µà third ·≈– fourth ventricle ¡’¢π“¥ª°µ‘· ¥ß«à“

¡’ obstruction at foramen of Monro „Àâæ‘®“√≥“«à“¡’°“√Õÿ¥µ—π¢Õß foramen of Monro ¢â“ß‡¥’¬«À√◊Õ 2 ¢â“ß

1. ∂â“¡’°“√Õÿ¥µ—π¢â“ß‡¥’¬«∑”„Àâ‡°‘¥ monoventricular HCP „Àâæ‘®“√≥“«à“¡’ mass lesion ∑’Ë lateral

ventricle À√◊Õ‰¡à

1.1 ∂â“¡’ mass lesion ‡™àπ subependymal giant cell astrocytoma ∑’Ëæ∫„π‚√§ tuberous

sclerosis6 ‡ªìπµâπ „Àâ√—°…“µ“¡ “‡Àµÿ √à«¡°—∫æ‘®“√≥“∑” CSF diversion µ“¡§«“¡‡À¡“– ¡

1.2 ∂â“‰¡à¡’ mass lesion „Àâæ‘®“√≥“∑” CSF diversion ¬°‡«âπ°√≥’ ß —¬«à“¡’ active purulent

meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“ infection „ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent CSF

diversion

2. ∂â“¡’°“√Õÿ¥µ—π∑—Èß 2 ¢â“ß ∑”„Àâ‡°‘¥ biventricular HCP „Àâæ‘®“√≥“«à“¡’ mass lesion ∑’Ë√–¥—∫ third

ventricle À√◊Õ‰¡à

2.1 ∂â“¡’ mass lesion ‡™àπ craniopharyngioma, ependymoma ‡ªìπµâπ „Àâ√—°…“µ“¡ “‡Àµÿ

√à«¡°—∫æ‘®“√≥“∑” CSF diversion µ“¡§«“¡‡À¡“– ¡

2.2 „π°√≥’∑’Ë‰¡à¡’ mass à«π„À≠à‡°‘¥®“° atresia of both foramen of Monro „Àâæ‘®“√≥“∑”

CSF diversion ¬°‡«âπ°√≥’ ß —¬«à“¡’ active purulent meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“

infection „ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent CSF diversion

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 9

·ºπ¿Ÿ¡‘∑’Ë 2.3

·π«∑“ß°“√∫”∫—¥√—°…“ºŸâªÉ«¬∑’Ë¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”®“°°“√Õÿ¥µ—ππÈ”‰¢ ——πÀ≈—ß

∑’Ëµ”·ÀπàßµË”°«à“ third ventricle

(Management of patients with hydrocephalus from obstruction distal to third ventricle)

* „π°√≥’∑’Ë ß —¬«à“¬—ß¡’ active purulent meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“ infection

„ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent CSF diversion

10 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 2.3

‡¡◊ËÕµ√«®æ∫ dilatation of lateral ventricles ·≈– third ventricle „Àâæ‘®“√≥“¥Ÿ«à“ ¡’ dilatation ¢Õß

fourth ventricle À√◊Õ‰¡à

1. ∂â“ fourth ventricle ‰¡à‚µ «‘π‘®©—¬«à“‡ªìπ aqueductal obstruction

1.1 ∂â“¡’ mass lesion ∑’Ë‡ªìπ “‡Àµÿ¢Õß HCP ‡™àπ tectal astrocytoma, pineal region tumor,

posterior fossa tumor, cysticercosis ‡ªìπµâπ „Àâ√—°…“µ“¡ “‡Àµÿπ—Èπ Ê √à«¡°—∫æ‘®“√≥“∑” CSF diversion

1.2 ∂â“‰¡à¡’ mass «‘π‘®©—¬«à“‡ªìπ aqueductal stenosis ÷́ËßÕ“®‡ªìπ§«“¡º‘¥ª°µ‘¡“·µà°”‡π‘¥

(congenital) À√◊Õ‡°‘¥¢÷Èπ¿“¬À≈—ß (acquired) „Àâ°“√√—°…“‚¥¬°“√∑” CSF diversion „π°√≥’∑’Ë ß —¬«à“¡’ active

purulent meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“ infection „ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent

CSF diversion

2. ∂â“ fourth ventricle ‚µ „Àâ·¬°«à“‡ªìπ§«“¡º‘¥ª°µ‘¡“·µà°”‡π‘¥ (congenital) ‡™àπ Dandy Walker

syndrome, Chiari malformation ‡ªìπµâπ „Àâ√—°…“µ“¡ “‡Àµÿπ—Èπ Ê À√◊Õ∂â“‡ªìπ “‡Àµÿ∑’Ë‡°‘¥¢÷Èπ¿“¬À≈—ß

(acquired) „Àâæ‘®“√≥“«à“¡’ mass lesion À√◊Õ‰¡à

2.1 ∂â“¡’ mass lesion ∑’Ë‡ªìπ “‡Àµÿ¢Õß HCP ‡™àπ meningioma ∫√‘‡«≥ foramen magnum

‡ªìπµâπ „Àâ√—°…“µ“¡ “‡Àµÿπ—Èπ Ê √à«¡°—∫æ‘®“√≥“∑” CSF diversion µ“¡§«“¡‡À¡“– ¡

2.2 ∂â“‰¡à¡’ mass lesion „Àâæ‘®“√≥“∑” CSF diversion „π°√≥’∑’Ë ß —¬«à“¬—ß¡’ active purulent

meningitis/ventriculitis µâÕßµ√«® CSF ·≈–√—°…“ infection „ÀâÀ“¬°àÕπ®÷ßæ‘®“√≥“∑” permanent CSF

diversion

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 11

∫∑∑’Ë 3

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°‡°‘¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß

·≈– ß —¬«à“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Management of preterm babies with IVH suspected of HCP)

®“°°“√»÷°…“¢Õß Ment ·≈–§≥–7 „π‡¥Á°‡°‘¥°àÕπ°”Àπ¥ ∑’Ë¡’Õ“¬ÿ§√√¿åπâÕ¬°«à“ 34 —ª¥“Àå À√◊Õ

πÈ”Àπ—°πâÕ¬°«à“ 1,500 °√—¡ æ∫«à“ ¡’Õÿ∫—µ‘°“√≥å¢Õß‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß (intraventricular hemorrhage :

IVH) √âÕ¬≈– 15 - 357, 8 ·≈– √âÕ¬≈– 20 - 50 ¢Õß IVH ®–‡°‘¥¿“«–‚æ√ß ¡Õß§—ËßπÈ”7, 8, 9, 10 (post

hemorrhagic hydrocephalus : PHH) ¥—ßπ—Èπ „π‡¥Á°‡°‘¥°àÕπ°”Àπ¥∑’Ë¡’ IVH §«√µ√«®À“«à“¡’ PHH À√◊Õ‰¡à

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 3

‡¥Á°‡°‘¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß·≈– ß —¬«à“¡’ HCP ·æ∑¬å§«√æ‘®“√≥“µ√«® ¡Õß¥â«¬

ultrasound À√◊Õ CT scan ∑ÿ°√“¬ (recommendation C) ∂â“‰¡àæ∫¿“«–‚æ√ß ¡Õß§—ËßπÈ”„Àâµ‘¥µ“¡¥Ÿ·≈

Õ¬à“ß„°≈â™‘¥µàÕ‰ª

∂â“æ∫¿“«–‚æ√ß ¡Õß§—ËßπÈ”·≈–¡’Õ“°“√Õ¬à“ß„¥Õ¬à“ßÀπ÷Ëß¥—ßµàÕ‰ªπ’È

1. Change in clinical condition ‡™àπ alteration of consciousness, irritable, lethargy vomiting

‡ªìπµâπ

2. Bulging of anterior fontanel

3. Accelerated head growth > 2 cm./wk. ¥Ÿ°√“ø„π‡¥Á°‡°‘¥°àÕπ°”Àπ¥ ¿“§ºπ«°∑’Ë 1

„Àâ∑”°“√√—°…“‡∫◊ÈÕßµâπ (temporizing measures) ‡™àπ LP11, EVD12, ventricular access device13, 14, early

shunting, medical treatment ‡™àπ acetazolamide, furosemide ‡ªìπµâπ (recommendation C) ·¡â«à“°“√√—°…“

¿“«–‚æ√ß ¡Õß§—ËßπÈ”¥â«¬¬“ acetazolamide, furosemide „πºŸâªÉ«¬∫“ß√“¬®–‰¥âº≈¥’1 ·µà¡’∫“ß√“¬ß“πæ∫«à“

‰¡à‰¥âº≈·≈–§«√√–¡—¥√–«—ß„π°“√„™â¬“¢π“¥ Ÿß°—∫‡¥Á°‡°‘¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß15, 16

(recommendation B) ∂â“„Àâ°“√√—°…“‡∫◊ÈÕßµâπ·≈â«ºŸâªÉ«¬¡’Õ“°“√§ß∑’Ë„Àâµ‘¥µ“¡¥ŸÕ“°“√µàÕ‰ª

À“°ºŸâªÉ«¬¡’Õ“°“√¡“°¢÷Èπ (worsening of clinical conditions) À√◊Õ‰¡à¥’‡∑à“∑’Ë§«√ À√◊Õ¡’ progressive

ventricular dilatation „Àâª√÷°…“ª√– “∑»—≈¬·æ∑¬å ‡æ◊ËÕæ‘®“√≥“∑” permanent CSF diversion ´÷Ëß·π–π”„Àâ

∑”‡¡◊ËÕ‡¥Á°¡’πÈ”Àπ—°¡“°°«à“ 1,500 °√—¡ ·≈– CSF protein πâÕ¬°«à“ 500 mg%17 (recommendation C)

À“°¬—ß‰¡à‰¥â‡°≥±å¥—ß°≈à“« ·π–π”„Àâ§ß°“√√—°…“‡∫◊ÈÕßµâπµàÕ‰ª ‡π◊ËÕß®“°‡¥Á°¡’‚Õ°“ ∑’Ë®–‡°‘¥ shunt obstruction

À√◊Õ skin break down

∂â“ºŸâªÉ«¬¡’¿“«–‚æ√ß ¡Õß‚µ·µà‰¡à¡’Õ“°“√º‘¥ª°µ‘¥—ß°≈à“«¢â“ßµâπ „Àâµ‘¥µ“¡Õ“°“√·≈–µ√«®

cranial ultrasound À√◊Õ CT scan ‡ªìπ§√—Èß§√“«µ“¡§«“¡‡À¡“– ¡

12 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

·ºπ¿Ÿ¡‘∑’Ë 3

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°§≈Õ¥°àÕπ°”Àπ¥∑’Ë¡’‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß

·≈– ß —¬¿“«–‚æ√ß ¡Õß§—ËßπÈ”

(Management of preterm baby with intraventricular hemorrhage suspected of hydrocephalus)

* Change in clinical condition means : alteration of consciousness, irritable, lethargy, vomiting

** 1. Lumbar puncture 2. External ventricular drainage

3. Ventricular access device 4. Medical treatment

*** Progressive

1. Worsening of clinical conditions 2. Progressive ventricular dilatation

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 13

∫∑∑’Ë 4

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°·√°§≈Õ¥∑’Ë¡’ myelomeningocele/encephalomeningocele

(Management of newborn infants with myelomeningocele/encephalomeningocele)

°“√»÷°…“¢Õß Lorber18 æ∫«à“√âÕ¬≈– 70 ¢Õß‡¥Á°·√°§≈Õ¥∑’Ë¡’ myelomeningocele ®–¡’¿“«–

‚æ√ß ¡Õß§—ËßπÈ” ®÷ß§«√µ‘¥µ“¡ºŸâªÉ«¬„π°≈ÿà¡π’È ‡æ◊ËÕ¥Ÿ¿“«–‚æ√ß ¡Õß§—ËßπÈ”Õ¬à“ß„°≈â™‘¥ µ“¡·ºπ¿Ÿ¡‘∑’Ë 4

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 4

ºŸâªÉ«¬ myelomeningocele À√◊Õ encephalomeningocele ·æ∑¬å§«√„Àâ§«“¡ ”§—≠„π°“√ºà“µ—¥ repair

myelomeningocele ‚¥¬‡√Á« ‡æ◊ËÕªÑÕß°—π°“√µ‘¥‡™◊ÈÕ∑“ß√–∫∫ª√– “∑ ∂â“ ∂“πæ¬“∫“≈„¥¡’§«“¡æ√âÕ¡·π–π”„Àâ

cranial ultrasound/CT (recommendation C) °àÕπºà“µ—¥ ‡æ◊ËÕª√–‡¡‘π¿“«–‚æ√ß ¡Õß§—ËßπÈ” ‚¥¬‰¡à∑”„Àâ

°“√ºà“µ—¥≈à“™â“ ∂â“æ∫ severe hydrocephalus Õ“®∑” CSF diversion ¥â«¬

„π ∂“πæ¬“∫“≈∑’Ë‰¡à¡’ª√– “∑»—≈¬·æ∑¬å §«√„ÀâºŸâªÉ«¬πÕπ§«Ë”µ≈Õ¥‡«≈“·≈–∑” wet dressing

‰«â∫π myelomeningocele ®“°π—Èπ àßºŸâªÉ«¬‰ªæ∫ª√– “∑»—≈¬·æ∑¬å ‡æ◊ËÕ∑”ºà“µ—¥‚¥¬‡√Á«

À≈—ßºà“µ—¥ repair myelomeningocele µâÕßµ‘¥µ“¡¥ŸÕ“°“√ºŸâªÉ«¬«à“ ¡’Õ“°“√‡≈«≈ßÀ√◊Õ‰¡à ‡™àπ Õ“°“√

∑’Ë· ¥ß¿“«–§«“¡¥—π„π°–‚À≈°»’√…– ŸßÀ√◊ÕÕ“°“√∑’Ë∫àß«à“®–¡’ Chiari crisis ‰¥â·°à laryngeal stridor,

drooling, increased tone in arms and legs, retropulsion of head (opisthotonic posturing), apneic spells

‡ªìπµâπ à«π encephalomeningocele ‰¡àæ∫√à«¡°—∫ Chiari malformation

°√≥’¡’ Chiari crisis µâÕß√’∫ àßµ√«® CT À√◊Õ MRI brain ‡æ◊ËÕª√–‡¡‘π§«“¡º‘¥ª°µ‘¢Õß ¡Õß

à«πÀ≈—ß (posterior fossa) ·≈–¿“«–‚æ√ß ¡Õß§—ËßπÈ”‚¥¬‡√Á« æ√âÕ¡„Àâ°“√√—°…“©ÿ°‡©‘π∑’Ë‡À¡“– ¡ ‡™àπ posterior

fossa decompression19 À√◊Õ immediate ventriculostomy ‡ªìπµâπ

°√≥’À≈—ßºà“µ—¥ repair ·≈â«Õ“°“√‡≈«≈ß·µà‰¡à¡’ Chiari crisis „Àâ àß ultrasound À√◊Õ CT brain

‚¥¬‡√Á« ‡æ◊ËÕª√–‡¡‘π§«“¡√ÿπ·√ß¢Õß¿“«–‚æ√ß ¡Õß§—ËßπÈ”®“°¢π“¥¢Õß ventricle ·≈– periventricular edema

·≈–„Àâ°“√∫”∫—¥√—°…“¥—ßπ’È

1. ∂â“¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”ª“π°≈“ß∂÷ß¡“°„Àâ∑” CSF diversion ‚¥¬‡√Á«

2. ∂â“‰¡à¡’¿“«–‚æ√ß ¡Õß§—ËßπÈ”À√◊Õ¡’‡≈Á°πâÕ¬ „Àâµ‘¥µ“¡Õ“°“√Õ¬à“ß„°≈â™‘¥ ‰¥â·°à «—¥ head

circumference ·≈–/À√◊Õµ√«® ultrasound À√◊Õ CT brain ‡ªìπ§√—Èß§√“« ‡¡◊ËÕ‡¥Á°¡’Õ“¬ÿµ—Èß·µà 6 —ª¥“Àå¢÷Èπ‰ª

·π–π”„Àâª√–‡¡‘πæ—≤π“°“√¢Õß‡¥Á° (psychomotor developmental assessment) Õ“∑‘‡™àπ Denver Develop-

mental Screening Test (DDST)20 ‡ªìπµâπ (recommendation C)

2.1 À“°ºŸâªÉ«¬¡’Õ“°“√√ÿπ·√ß¡“°¢÷Èπ ‰¥â·°à progressive HCP À√◊Õ lower cranial nerve

dysfunction À√◊Õ delayed psychomotor development „Àâæ‘®“√≥“∑” CSF diversion

14 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

2.2 ‡¡◊ËÕµ‘¥µ“¡ºŸâªÉ«¬Õ¬à“ß„°≈â™‘¥ À“°ºŸâªÉ«¬¡’Õ“°“√§ß‡¥‘¡·≈–¡’ psychomotor development ª°µ‘

·≈–‰¡à¡’Õ“°“√· ¥ß¢Õß Chiari crisis ·≈– ‡¡◊ËÕ∑” CT À√◊Õ US æ∫«à“¡’ cerebral cortex Àπ“ (¡’ cortical

mantle > 3.5 cm ‡¡◊ËÕºŸâªÉ«¬Õ“¬ÿ 5 ‡¥◊Õπ)21, 22 (recommendation C) ºŸâªÉ«¬ à«π„À≠à®–¡’°“√æ¬“°√≥å‚√§¥’

‡π◊ËÕß®“°¿“«–‚æ√ß ¡Õß§—ËßπÈ” à«π¡“°®–‡°‘¥À≈—ßºà“µ—¥ repair myelomeningocele encephalo-

meningocele ª√–¡“≥Àπ÷Ëß —ª¥“Àå ¥—ßπ—Èπ ∂â“‡¥Á°¡’Õ“°“√§ß∑’Ë„Àâæ‘®“√≥“µ√«® ultrasound À√◊Õ CT brain

À≈—ßºà“µ—¥ª√–¡“≥Àπ÷Ëß —ª¥“Àå ‡æ◊ËÕª√–‡¡‘π¿“«–‚æ√ß ¡Õß§—ËßπÈ” (¥Ÿµ“¡¢âÕ 1 ·≈– 2 ¥—ß°≈à“«¢â“ßµâπ)

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 15

·ºπ¿Ÿ¡‘∑’Ë 4

·π«∑“ß°“√∫”∫—¥√—°…“‡¥Á°·√°§≈Õ¥∑’Ë¡’ myelomeningocele À√◊Õ encephalomeningocele

(Management of newborn with myelomeningocele or encephalomeningocele)

* „π ∂“πæ¬“∫“≈∑’Ë¡’§«“¡æ√âÕ¡§«√∑” cranial US À√◊Õ CT °àÕπºà“µ—¥ repair myelomeningocele

or encephalomeningocele ∂â“‰¡à∑”„Àâ°“√ºà“µ—¥µâÕß≈à“™â“

** Chiari crisis (æ∫√à«¡°—∫ myelomeningocele ª√–¡“≥ 5% ·µà‰¡àæ∫√à«¡°—∫ encephalomeningocele)

ºŸâªÉ«¬®–¡’ symptomatic brainstem compression ´÷Ëß¡’Õ“°“√ retropulsion of head (opisthotonic

posturing), laryngeal stridor, drooling, increased tone in arms and legs, apnea

*** Emergency management ‡™àπ posterior fossa decompression, immediate ventriculostomy ‡ªìπµâπ

16 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

∫∑∑’Ë 5



„πºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë¡’Õ“°“√ gait disturbance, dementia, urinary incontinence „Àâ ß —¬«à“Õ“®®–‡ªìπ

¿“«– ¡Õß§—ËßπÈ”™π‘¥§«“¡¥—π„π ¡Õß‰¡à Ÿß (normal pressure hydrocephalus, NPH) À“°ºŸâªÉ«¬¡’Õ“°“√

§√∫∑—Èß “¡Õ¬à“ß„Àâ ß —¬«à“®–‡ªìπ classical NPH ·µàºŸâªÉ«¬ à«π„À≠à¡’Õ“°“√‡æ’¬ß gait disturbance Õß„π

“¡¡’ dementia ·≈–Õ’°§√÷ËßÀπ÷Ëß¡’ urinary incontinence23

∂â“ºŸâªÉ«¬¡’Õ“°“√‡æ’¬ßÕ¬à“ß„¥Õ¬à“ßÀπ÷Ëß®–µâÕß·¬°®“°‚√§Õ◊Ëπ Ê ‡™àπ Alzheimerûs disease,

vascular dementia, chronic subdural hematoma ‡ªìπµâπ Õ“°“√ gait disturbance „π NPH ¡’≈—°…≥– short

stepped gait ´÷ËßµâÕß·¬°®“° myelopathy À√◊Õ Parkinsonism à«πÕ“°“√ urinary incontinence ¡’≈—°…≥–

°≈—Èπªí “«–‰¡à‰¥â (uninhibited urinary incontinence) µâÕß·¬°®“°‚√§Õ◊Ëπ Ê ¢Õß√–∫∫∑“ß‡¥‘πªí “«–

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 5

ºŸâªÉ«¬∑’Ë ß —¬ NPH „Àâ àßµ√«® CT À√◊Õ MRI brain ‡æ◊ËÕ¥Ÿ«à“¡’‚æ√ß ¡Õß‚µ°«à“ª°µ‘À√◊Õ‰¡à

∂â“¢π“¥ª°µ‘„ÀâÀ“ “‡ÀµÿÕ◊Ëπ Ê ·≈–√—°…“µ“¡ “‡Àµÿπ—Èπ Ê À“°¢π“¥„À≠à°«à“ª°µ‘„Àâ®”·π°«à“‡ªìπ¿“«– ¡Õß

§—ËßπÈ”·∫∫„¥

1. ∂â“‚æ√ß ¡Õß‚µ°«à“ª°µ‘·≈–æ∫ ventricular obstruction æ‘®“√≥“„Àâ°“√∫”∫—¥√—°…“µ“¡·ºπ¿Ÿ¡‘∑’Ë

2.1, 2.2, 2.3

2. ∂â“‚æ√ß ¡Õß‚µ°«à“ª°µ‘·µà‰¡àæ∫ ventricular obstruction „Àâæ‘®“√≥“Õ“°“√ Õ“°“√· ¥ß ·≈–

º≈°“√µ√«® CT/MRI brain

2.1 „Àâ«‘π‘®©—¬«à“‡ªìπ NPH ‡¡◊ËÕ¡’ clinical criteria Õ¬à“ßπâÕ¬ 2 „π 3 ¢âÕ √à«¡°—∫ suggestive

radiographic imaging

Criteria for diagnosis of NPH (modified from reference 23 - 25)

1) Clinical : ºŸâªÉ«¬ ŸßÕ“¬ÿ∑’Ë¡’Õ“°“√

● gait disturbance

● dementia

● urinary incontinence23

‚¥¬Õ“°“√‡À≈à“π’ÈµâÕß·¬°®“° “‡ÀµÿÕ◊Ëπ Ê

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 17

2) Radiographic imaging

● CT scan

- Rounding of frontal horn of lateral ventricles with periventicular edema

- Symmetrical dilatation of lateral ventricles out of proportion to sulcal enlargement24

● MRI

- Rounding of frontal horn of lateral ventricles with periventicular edema

- Symmetrical dilatation of lateral ventricles out of proportion to sulcal enlargement24

- Normal hippocampus

- Aqueductal çflow voidé sign25

2.2 ∂â“ criteria ‰¡à§√∫·µà¬—ß ß —¬„π°“√«‘π‘®©—¬ „Àâæ‘®“√≥“µ√«®‡æ‘Ë¡‡µ‘¡µ“¡§«“¡‡À¡“– ¡

(Optional) ¥—ßπ’È

2.2.1 Invasive investigation

- serial lumbar puncture À√◊Õ lumbar drainage26 ‡æ◊ËÕ¬◊π¬—π°“√«‘π‘®©—¬·≈–

ª√–‡¡‘π°“√µÕ∫ πÕßµàÕ°“√√—°…“ (therapeutic diagnosis)

- ICP monitoring

2.2.2 Non invasive investigation

- MRI ‡æ◊ËÕ‡æ‘Ë¡§«“¡™—¥‡®π„π°“√«‘π‘®©—¬ („π°√≥’∑’Ë¬—ß‰¡à‰¥âµ√«®)

- CSF flow studies in MRI : increased velocity CSF flow27, 28

- MRS (magnetic resonance spectroscopy) : lactate peak in lateral ventricles29

∂â“º≈°“√µ√«®‡æ‘Ë¡‡µ‘¡‡¢â“‰¥â°—∫ NPH „Àâæ‘®“√≥“∑” CSF diversion À“°‡¢â“‰¥â°—∫ “‡ÀµÿÕ◊Ëπ

„Àâ√—°…“µ“¡ “‡Àµÿπ—Èπ Ê

18 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

·ºπ¿Ÿ¡‘∑’Ë 5



* „π ∂“π∑’Ë∑’Ë¡’§«“¡æ√âÕ¡∑’Ë®–µ√«® MRI ‰¥â

** Normal pressure hydrocephalus µâÕß¡’≈—°…≥–µ“¡ Criteria for diagnosis of NPH (§”Õ∏‘∫“¬

·ºπ¿Ÿ¡‘∑’Ë 5)

*** Further investigation Õ“®æ‘®“√≥“∑”µ“¡§«“¡‡À¡“– ¡·≈–»—°¬¿“æ¢Õß ∂“πæ¬“∫“≈

(§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 5)

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 19

Reference

1. Poca MA, Sahuquillo J. Short-term medical management of hydrocephalus. Expert Opin

Pharmacother. 2005; 6(9): 1525-38.

2. Persson EK, Hagberg G, Uvebrant P. Hydrocephalus prevalence and outcome in a population-

based cohort of children born in 1989 - 1998. Acta Paediatr. 2005; 94(6): 726-32.

3. Forrester MB, Merz RD. Descriptive epidemiology of congenital hydrocephaly in Hawaii, 1986 -

2000. Hawaii Med J. 2005; 64(2): 38-41.

4. Nevo Y, Kramer U, Shinnar S, Leitner Y, Fattal-Valevski A, Villa Y, Harel S. Macrocephaly in

children with developmental disabilities. Pediatr Neurol. 2002; 27(5): 363-8.

5. Adeloye A, Khare R. Ultrasonographic study of children suspected of hydrocephalus at the

Queen Elizabeth Central Hospital in Blantyre, Malawi. East Afr Med J. 1997; 74(4): 267-70.

6. de Chadarevian JP, Hollenberg RD. Subependymal giant cell tumor of tuberous sclerosis. A light

and ultrastructural study. J Neuropathol Exp Neurol. 1979; 38(4): 419-33.

7. Ment LR, Keller MS, Duncan CC. Intraventricular hemorrhage of the preterm neonate. In: Swaiman

KF, Ashwal S. Pediatric neurology principles and practice (3rd edition). New York. 1999: 205.

8. Szymonowicz W, Yu VY, Lewis EA. Post-haemorrhagic hydrocephalus in the preterm infant.

Aust Paediatr J. 1985 Aug; 21(3): 175-9.

9. Kazan S, Gura A, Ucar T, Korkmaz E, Ongun H, Akyuz M. Hydrocephalus after intraventricular

hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors for

ventriculoperitoneal shunting. Surg Neurol. 2005; 64 Suppl 2: S77-81; discussion S81.

10. Rahman N, Murshid WR, Jamjoom ZA, Jamjoom A. Neurosurgical management of intraventricular

haemorrhage in preterm infants. J Pak Med Assoc. 1993 Oct; 43(10): 195-200.

11. Muller W, Urlesberger B, Maurer U, Kuttnig-Haim M, Reiterer F, Moradi G, Pichler G. Serial

lumbar tapping to prevent posthaemorrhagic hydrocephalus after intracranial haemorrhage in

preterm infants. Wien Klin Wochenschr. 1998 Oct 2; 110(18): 631-4.

12. Berger A, Weninger M, Reinprecht A, Haschke N, Kohlhauser C, Pollak A. Long-term experience

with subcutaneously tunneled external ventricular drainage in preterm infants. Childs Nerv Syst.

2000 Feb; 16(2): 103-9; discussion 110.

13. Hudgins RJ, Boydston WR, Gilreath CL. Treatment of posthemorrhagic hydrocephalus in the

preterm infant with a ventricular access device. Pediatr Neurosurg. 1998 Dec; 29(6): 309.

14. Richard E, Cinalli G, Assis D, Pierre-Kahn A, Lacaze-Masmonteil T. Treatment of post-haemorrhage

ventricular dilatation with an Ommayaûs reservoir: management and outcome of 64 preterm

infants. Childs Nerv Syst. 2001 May; 17(6): 334-40.

15. Kennedy CR, Ayers S, Campbell MJ, Elbourne D, Hope P, Johnson A. Randomized, controlled

trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy:

follow-up at 1 year. Pediatrics. 2001 Sep; 108(3): 597-607.

20 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

16. [No authors listed] International randomised controlled trial of acetazolamide and furosemide in

posthaemorrhagic ventricular dilatation in infancy. International PHVD Drug Trial Group.

Lancet. 1998; 352(9126): 433-40.

17. McCallum JE, Turbeville D. Cost and outcome in premature infants with intraventricular

hemorrhage. Pediatr Neurosurg. 1994; 20: 63-67

18. Lorber J. Results of treatment of myclomeningocele: an analysis of 524 unseluted cases with

special reference to possible selection for treatment. Dev Med Child Neurol 1971; 13: 279.

19. Vandertop WP, Asai A, Hoffman HJ, Drake JM, Humphreys RP, Rutka JT, Becker LE. Surgical

decompression for symptomatic Chiari II malformation in neonates with myelomeningocele.

J Neurosurg. 1992 Oct; 77(4): 541-4.

20. Rekate HL. To shunt or not to shunt: hydrocephalus and dysraphism. Clin Neurosurg. 1985;

32: 593-607.

21. Young HF, Nulsen FE, Weiss MH, Thomas P. The relationship of intelligence and cerebral

mantle in treated infantile hydrocephalus. (IQ potential in hydrocephalic children). Pediatrics.

1973 Jul; 52(1): 38-44.

22. Nulsen FE, Rekate HL. Results of treatment of hydrocephalus as a guide to prognosis and

management. In: McLaurin RL, ed. Pediatric Neurosurgery of the developing Nervous System.

New York: Grune and Stratton, 1982: 229-41

23. Ishikawa M. Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurol Med Chir

(Tokyo). 2004 Apr; 44(4): 222-3.

24. Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T. CSF spaces in idiopathic normal

pressure hydrocephalus: morphology and volumetry. (Am J Neuroradiol). 1998 Aug; 19(7):

1277-84.

25. Bradley WG Jr, Kortman KE, Burgoyne B. Flowing cerebrospinal fluid in normal and

hydrocephalic states: appearance on MR images. Radiology. 1986 Jun; 159(3): 611-6.

26. Krauss JK, Regel JP. The predictive value of ventricular CSF removal in normal pressure

hydrocephalus. Neurol Res. 1997 Aug; 19(4): 357-60.

27. Mase M, Yamada K, Banno T, Miyachi T, Ohara S, Matsumoto T. Quantitative analysis of CSF

flow dynamics using MRI in normal pressure hydrocephalus. Acta Neurochir Suppl. 1998; 71: 350-3.

28. Gideon P, Stahlberg F, Thomsen C, Gjerris F, Sorensen PS, Henriksen O. Cerebrospinal fluid flow

and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology.

1994 Apr; 36(3): 210-5.

29. Kizu O, Yamada K, Nishimura T. Proton chemical shift imaging in normal pressure

hydrocephalus. (Am J Neuroradiol). 2001 Oct; 22(9): 1659-64.

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 21

¿“§ºπ«° 1

Õ“°“√· ¥ß¢Õß¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß„π‡¥Á°‡≈Á°

(Signs of increased intracranial pressure in infants)

√Ÿª∑’Ë 1 Tensed and bulged anterior fontanelle

√Ÿª∑’Ë 2 Dilated scalp vein

22 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

√Ÿª∑’Ë 3 °“√µ√«®¥â«¬«‘∏’ transillumination ‚¥¬„™â‰ø©“¬ àÕß∑’Ë anterior fontanel

√Ÿª∑’Ë 4 Transillumination test

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 23

√Ÿª∑’Ë 5 Fronto-ethmoidal encephalomeningocele

√Ÿª∑’Ë 6 Myelomeningocele

24 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

√Ÿª∑’Ë 9 MRI of Chiari malformation

√Ÿª∑’Ë 7 Ultrasound of hydrocephalus √Ÿª∑’Ë 8 MRI of intraventricular tumor

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 25

GROWTH RECORD FOR PREMATURE INFANTS

In relation to

GESTATIONAL AGE AND FETAL AND INFANT NORMS

(combined sexes)

√Ÿª∑’Ë 10 ·ºπ¿Ÿ¡‘· ¥ß§à“ª°µ‘¢Õß°“√‡®√‘≠‡µ‘∫‚µ¢Õß∑“√°∑’Ë§≈Õ¥°àÕπ°”Àπ¥®π∂÷ßÕ“¬ÿ 1 ªï

·°πµ—Èß· ¥ßπÈ”Àπ—° à«π Ÿß ‡ âπ√Õ∫«ß¢Õß»’√…–

·°ππÕπ· ¥ßÕ“¬ÿ„π§√√¿åµ—Èß·µà 26 —ª¥“Àå ®π∂÷ßÕ“¬ÿÀ≈—ß§≈Õ¥ 1 ªï

(From Babson SB, Benda GI. Growth record for premature infants in relation to

gestational age and fetal and infant norms (combined sexes). J Pediatr 1989;

89: 814-820.)

26 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

√Ÿª∑’Ë 11 ·ºπ¿Ÿ¡‘· ¥ß§à“‡ âπ√Õ∫«ß»’√…– (occipito-frontal circumference; OFC)

„π‡¥Á°Õ“¬ÿµ—Èß·µà·√°‡°‘¥∂÷ß 3 ªï

·°πµ—Èß· ¥ß§à“‡ âπ√Õ∫«ß»’√…–

·°ππÕπ· ¥ßÕ“¬ÿµ—Èß·µà·√°‡°‘¥∂÷ß 3 ªï

(From DeMyer W. Technique of the neurologic examination.

A programmed text. 4th ed. New York: McGraw-Hill, 1994.)

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 27

¿“§ºπ«° 2

¿“æ∂à“¬∑“ß√—ß ’„πºŸâªÉ«¬ normal pressure hydrocephalus

(MR imaging of normal pressure hydrocephalus)

√Ÿª∑’Ë 12 Axial T2W MR

shows ventriculomegaly.

√Ÿª∑’Ë 13 Sagittal T1W MR

shows aqueductal flow void sign (arrow).

√Ÿª∑’Ë 14 T2W MR

shows enlarged ventricles with

rounded frontal horns.

√Ÿª∑’Ë 15 Axial FLAIR MR

shows ventriculomegaly out of

proportion to sulcal enlargement.

√Ÿª∑’Ë 16 Axial CT scan with contrast

media shows symmetrical dilatation of

ventricles out of proportion to sulcal

enlargement.

√Ÿª∑’Ë 17 Axial CT scan with contrast

media shows frontal and occipital

periventricular hypodensities suggest

transependymal CSF flow.

√Ÿª∑’Ë 12 √Ÿª∑’Ë 13

√Ÿª∑’Ë 14 √Ÿª∑’Ë 15

√Ÿª∑’Ë 16 √Ÿª∑’Ë 17

28 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

¿“æ∂à“¬ MRS ‡æ◊ËÕµ√«®¥Ÿ lactate peak

√Ÿª∑’Ë 18 Proton MR spectra (TR/TE, 2000/135) in the patient with NPH.

Proton MR spectra (TR/TE, 2000/135) in the patient with NPH.

(Upper left) axial T1W MR image. A box outlines volume of interest, which includes the bodies of lateral

ventricles in the hemisphere. Lower left corner shows spectra from the body of the left lateral ventricle and

surrounding parenchyma. The spectrum from the voxel of the parenchyma (white arrow) shows normal

spectral pattern (upper right). The spectrum from the voxel in the body of left lateral ventricle (black

arrow) shows the lactate peak (lower right). NAA, Cho, and Cr peaks also are observed, suggesting that

this intraventricular voxel contains periventricular brain tissue

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 29

√Ÿª∑’Ë 19 Proton MR spectra (TR/TE, 2000/135) in two patients with NPH.

Proton MR spectra (TR/TE, 2000/135) in two patients with NPH. The spectra obtained from

periventricular regions (upper row) with the intraventricular spectra (lower row) are shown. Apparent

inverted doublet peaks at 1.3 ppm are observed in the intraventricular spectrum of one case (left side) and

can be recognized as lactate peaks. In the other case (right side), good qualities of lactate peaks are seen

compared with the peaks from the periventricular region in the upper row

30 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

√Ÿª∑’Ë 20 Proton MR spectra (TR/TE, 2000/135) before and after continuous spinal drainage

Proton MR spectra (TR/TE, 2000/135) before and after continuous spinal drainage in the lateral

ventrical of a patient with NPH. The spectra were obtained from a intraventricular voxel (black arrow in

upper left). Before treatment, lactate peaks are observed as inverted double peaks at 1.3 ppm from the

intraventricular voxel of NPH (lower left). Cho, Cr, and NAA peaks suggest partial volume artifact from

periventricular brain tissue. A metabolic image of lactate (upper right) before treatment shows that lactate

is confined to the lateral ventricles and surroundings. After treatment, lactate is not observed clearly (lower

right).

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 34

¿“§ºπ«° 3

CSF diversion

¿“«–‚æ√ß ¡Õß§—ËßπÈ” (Hydrocephalus) ¡’º≈„Àâ°“√∑”ß“π¢Õß ¡Õß‰¡à “¡“√∂¥”‡π‘π‰ª‰¥âÕ¬à“ßª°µ‘

·≈–¡’·π«‚πâ¡®–∑”„Àâ§«“¡¥—π„π°–‚À≈°»’√…– Ÿß¢÷Èπ À“°‰¡à‰¥â√—∫°“√∫”∫—¥√—°…“Õ¬à“ß∂Ÿ°µâÕßÕ“®∑”„Àâ

‡°‘¥§«“¡æ‘°“√Õ¬à“ß∂“«√ À√◊Õ‡ ’¬™’«‘µ‰¥â

°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ”¡’À≈—°°“√√—°…“¥—ßπ’È

1) °“√„™â¬“≈¥Õ—µ√“°“√ √â“ß CSF «‘∏’π’È®–„™â√—°…“°√≥’∑’Ë¿“«–‚æ√ß ¡Õß§—ËßπÈ”‰¡à√ÿπ·√ß º≈°“√

√—°…“‰¡à·πàπÕπ ¥—ßπ—Èπ „π¿“«–‚æ√ß ¡Õß§—ËßπÈ”Õ¬à“ß√ÿπ·√ß ®÷ß‰¡à·π–π”„Àâ√—°…“¥â«¬«‘∏’π’È‡æ’¬ß«‘∏’‡¥’¬«

2) °“√√—°…“¥â«¬°“√√–∫“¬ CSF ÕÕ°®“°‚æ√ß ¡Õß À√◊Õ subarachnoid space (CSF diversion)

¡’À≈“¬«‘∏’ °“√√—°…“π’È®–™à«¬≈¥§«“¡¥—π„π°–‚À≈°»’√…–‰¥âÕ¬à“ß√«¥‡√Á« ¡’ª√– ‘∑∏‘¿“æ·≈–‰¥âº≈·πàπÕπ

°«à“°“√√—°…“¥â«¬¬“ ¥—ßπ—Èπ °“√∑” CSF diversion ®÷ß‡ªìπ«‘∏’∑’Ë‡À¡“– ¡„π°“√√—°…“ºŸâªÉ«¬∑’Ë¡’¿“«–‚æ√ß ¡Õß

§—ËßπÈ”∑’Ë√ÿπ·√ß

CSF diversion ‡ªìπ«‘∏’°“√√—°…“‚¥¬°“√√–∫“¬ CSF ÕÕ°®“°‚æ√ß ¡Õß À√◊Õ subarachnoid space

´÷Ëß®”·π°‡ªìπ 3 «‘∏’ ¥—ßπ’È

1) «‘∏’√–∫“¬ CSF ÕÕ°™—Ë«§√“« (Temporary diversion or drainage) „™â ”À√—∫°√≥’∑’Ë¡’ CSF §—Ëß

∑’Ë‡°‘¥®“° “‡Àµÿ°“√Õÿ¥µ—π™—Ë«§√“« (∑’Ë§“¥«à“®– “¡“√∂°≈—∫¡“ Ÿà¿“«–ª°µ‘¿“¬„π‰¡à‡°‘π 2 - 3 —ª¥“Àå ‡™àπ

intraventricular hemorrhage ‡ªìπµâπ À√◊Õ°√≥’ acute hydrocephalus ́ ÷Ëß®”‡ªìπµâÕß√–∫“¬ CSF ÕÕ°Õ¬à“ß√«¥‡√Á«

·µà ¿“«–„π¢≥–π—Èπ‰¡àæ√âÕ¡ ”À√—∫°“√ºà“µ—¥ ́ ÷Ëß°“√∑” Temporary diversion or drainage π’È “¡“√∂∑”‰¥â∑—Èß

bed side À√◊Õ„πÀâÕßºà“µ—¥ “¡“√∂®”·π°‰¥â‡ªìπ 2 «‘∏’ §◊Õ

1.1) Ventricular tapping or drainage À√◊Õ ventriculostomy Õ“®µâÕß∑”„π¿“«– acute

hydrocephalus ∑’Ë‰¡à “¡“√∂„Àâ°“√√—°…“∑’Ë “‡Àµÿ‰¥â‚¥¬µ√ß„π¢≥–π—Èπ

1.2) Lumbar puncture À√◊Õ lumbar drainage „™â‰¥â‡©æ“–„π extraventricular obstructive

hydrocephalus À√◊Õ communicating hydrocephalus ‡∑à“π—Èπ ÷́Ëß à«π„À≠à‡°‘¥®“°°“√Õÿ¥µ—π∫√‘‡«≥ basal

cisterns ·µà‰¡àÕÿ¥µ—π„π spinal subarachnoid space ‡™àπ Postmeningitic hydrocephalus, TB meningitis ‡ªìπµâπ

32 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

2) Permanent CSF diversion ®–∑”„π°√≥’∑’Ë¿“«–‚æ√ß ¡Õß§—ËßπÈ”∑’Ë‡°‘¥®“° “‡Àµÿ∑’Ë‰¡à “¡“√∂

À“¬‡Õß‰¥â ‡™àπ congenital hydrocephalus À√◊Õ ‰¥â∑” temporary CSF diversion ‡ªìπ√–¬–‡«≈“π“π·≈–

§“¥«à“®–µâÕß¡’ªí≠À“‚æ√ß ¡Õß§—ËßπÈ”µàÕ‰ª„π√–¬–¬“« ∑”„Àâ¡’§«“¡‡ ’Ë¬ßµàÕ°“√µ‘¥‡™◊ÈÕ ́ ÷Ëß«‘∏’°“√∑’Ëπ‘¬¡„™â ‰¥â·°à

2.1) Ventricular CSF shunt insertion ¡’À≈“¬«‘∏’ ‰¥â·°à

2.1.1) Ventriculoperitoneal shunt (VP shunt)

2.1.2) Ventriculoatrial shunt (VA shunt)

2.1.3) Ventriculopleural shunt

2.1.4) Ventriculocisternal shunt

2.1.5) Ventriculosubgaleal shunt

«‘∏’∑’Ëπ‘¬¡∑”°—π¡“°®π‡ªìπ«‘∏’¡“µ√∞“π„πªí®®ÿ∫—π ·≈–¡—°®–‡≈◊Õ°∑”°àÕπ«‘∏’Õ◊Ëπ Ê ‰¥â·°à

ventriculoperitoneal shunt (VP shunt) ·≈– ventriculoatrial shunt (VA shunt)

°àÕπºà“µ—¥ ventricular shunting »—≈¬·æ∑¬åµâÕß·πà„®«à“ºŸâªÉ«¬‰¡à¡’ªí≠À“‡√◊ËÕß active purulent

infection ‰¡à¡’≈‘Ë¡‡≈◊Õ¥∑’ËÕ“®∑”„Àâ∑àÕ¢Õß shunt Õÿ¥µ—π ·≈–§“¥«à“¿“«–π’È®–‡ªìπÕ¬à“ßµàÕ‡π◊ËÕßµàÕ‰ªÕ’°π“π

2.2) Lumbar subarachnoid-peritoneal shunt (LP shunt) «‘∏’π’È„™â‰¥â‡©æ“– communicating

hydrocephalus ‡∑à“π—Èπ

2.3) Third ventriculostomy „™â„π°√≥’ obstructive hydrocephalus ∑’Ë¡’°“√Õÿ¥µ—πÕ¬ŸàµË”°«à“ third

ventricle ·µà‰¡à·π–π”„Àâ„™â«‘∏’π’È„π°“√√—°…“ºŸâªÉ«¬∑’Ë¡’ hydrocephalus ∑’Ë‡°‘¥√à«¡°—∫ myelomeningocele

„π°√≥’∑’Ë∑√“∫«à“¡’ HCP ®“° Ventricular obstruction Àâ“¡∑” LP shunt ‚¥¬‡¥Á¥¢“¥ ‡æ√“–¡’

§«“¡‡ ’Ë¬ß∑’Ë®–‡°‘¥ acute tonsillar herniation ´÷ËßÕ“®®–∑”„ÀâºŸâªÉ«¬À¬ÿ¥À“¬„®·≈–‡ ’¬™’«‘µ‰¥â„π∑—π∑’

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 33

¿“§ºπ«° 4

34 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

§”·π–π”°“√∑¥ Õ∫æ—≤π“°“√ ¥â«¬ DENVER II (©∫—∫¿“…“‰∑¬)

1. æ¬“¬“¡∑”„Àâ‡¥Á°¬‘È¡‚¥¬¬‘È¡°—∫‡¥Á° æŸ¥§ÿ¬À√◊Õ‚∫°¡◊Õ‡≈àπ°—∫‡¥Á° ·µàÀâ“¡ —¡º— µ—«‡¥Á°

2. ‡¥Á°µâÕß®âÕß¡Õß∑’Ë¡◊Õ —°§√ŸàÀπ÷Ëß ª√–¡“≥ 3 - 4 «‘π“∑’

3. æàÕ·¡àºŸâ‡≈’È¬ß¥ŸÕ“®™à«¬·π–π”«‘∏’·ª√ßøíπ ·≈–„ à¬“ ’øíπ„Àâ∫π·ª√ß

4. ‡¥Á°‰¡à®”‡ªìπµâÕßºŸ°‡™◊Õ°√Õß‡∑â“ µ‘¥´‘ªÀ√◊Õ°√–¥ÿ¡‡ ◊ÈÕ¥â“πÀ≈—ß‰¥â¥â«¬µπ‡Õß

5. ‡§≈◊ËÕπ°≈ÿà¡‰À¡æ√¡Õ¬à“ß™â“ Ê ®“°¥â“πÀπ÷Ëß‰ªÕ’°¥â“πÀπ÷Ëß ‡ªìπ‡ âπ‚§âß√–¬–Àà“ß®“°Àπâ“‡¥Á°ª√–¡“≥ 8 π‘È«

6. ºà“π ∂â“‡¥Á°®—∫°√ÿâß°√‘Èß‡¡◊ËÕπ”°√ÿâß°√‘Èß‰ª —¡º— À≈—ß¡◊ÕÀ√◊Õπ‘È«¢Õß‡¥Á°

7. ºà“π ∂â“‡¥Á°æ¬“¬“¡¡ÕßÀ“°≈ÿà¡‰À¡æ√¡∑’Ëµ°≈ß∫πæ◊Èπ ºŸâ∑¥ Õ∫§«√ª≈àÕ¬°≈ÿà¡‰À¡æ√¡Õ¬à“ß√«¥‡√Á«‚¥¬‰¡à¢¬—∫·¢π„π¢≥–∑’Ë‡¥Á°¡Õß

8. ‡¥Á°µâÕß‡ª≈’Ë¬π¡◊Õ∂◊Õ°âÕπ‰¡â®“°¡◊Õ¢â“ßÀπ÷Ëß‚¥¬‰¡àµâÕß„™â√à“ß°“¬ ª“° À√◊Õ‚µä–™à«¬

9. ºà“π ∂â“‡¥Á° “¡“√∂„™âπ‘È«À—«·¡à¡◊Õ à«π„¥°Á‰¥â·≈–π‘È«Õ◊ËπÀ¬‘∫≈Ÿ°‡°¥

10. ‡ âπµ√ß∑’Ë«“¥µâÕß∑”¡ÿ¡‰¡à‡°‘π 30 Õß»“ ®“°‡ âπµ—«Õ¬à“ß

11. °”¡◊Õ ™Ÿπ‘È«À—«·¡à¡◊Õ¢÷Èπæ√âÕ¡°—∫°√–¥‘°π‘È«À—«·¡à¡◊Õ ºà“π ∂â“‡¥Á°‡≈’¬π·∫∫·≈–‰¡à¢¬—∫π‘È«Õ◊Ëπ

12. ºà“π ∂â“«“¥‡ âπ«ß°≈¡™π°—π ‰¡àºà“π ∂â“«“¥‡ âπ«π‰ª‡√◊ËÕ¬ Ê 13. ∂“¡‡¥Á°«à“ ‡ âπ‰Àπ¬“«°«à“°—π (‰¡à„™à„À≠à°«à“) À¡ÿπ°√–¥“…

°≈—∫À—«·≈â«∂“¡´È” (ºà“π ∂â“∑”∂Ÿ° 3 „π 3 §√—Èß À√◊Õ 5 „π 6 §√—Èß)

14. ºà“π ∂â“‡ âπµ√ß 2 ‡ âπ µ—¥°—π∫√‘‡«≥µ√ß°≈“ßÀ√◊Õ„°≈â‡§’¬ß 15. „Àâ‡¥Á°ÕÕ°·∫∫°àÕπ ∂â“‡¥Á°∑”‰¡à‰¥â «“¥√Ÿª„Àâ‡¥Á°‡≈’¬π·∫∫«“¥µ“¡

¢âÕ∑¥ Õ∫¬àÕ¬∑’Ë 12, 14 ·≈– 15 ‰¡àµâÕß∫Õ°™◊ËÕ√Ÿª∑√ß ·≈–‰¡àµâÕß∑”„Àâ¥Ÿ„π¢âÕ 12 ·≈– 14

16. °“√„Àâ§–·ππ Õ«—¬«–∑’Ë‡ªìπ§Ÿà„Àâπ—∫‡ªìπ 1 à«π ‡™àπ ·¢π ¢“ ‡ªìπµâπ

17. „ à°âÕπ‰¡â 1 ™‘Èπ„π∂â«¬ ‡¢¬à“‡∫“ Ê „°≈âÀŸ‡¥Á°‚¥¬‰¡à„Àâ‡¥Á°‡ÀÁπ ∑”‡™àπ‡¥’¬«°—ππ’È°—∫ÀŸÕ’°¢â“ßÀπ÷Ëß

18. ™’È√Ÿª¿“æ·≈â«„Àâ‡¥Á°∫Õ°™◊ËÕ (‰¡à„Àâ§–·ππ∂â“‡¥Á°∑”·µà‡ ’¬ß) ∂â“‡¥Á°µÕ∫∂Ÿ°πâÕ¬°«à“ 4 ¿“æ „Àâ‡¥Á°™’È√Ÿª¿“æµ“¡§” —Ëß¢ÕßºŸâ∑¥ Õ∫

19. „™âµÿä°µ“‡ªìπÕÿª°√≥å ·≈â«∫Õ°„Àâ‡¥Á°™’È ®¡Ÿ° µ“ ÀŸ ª“° ¡◊Õ ‡∑â“ ∑âÕß º¡ ºà“π ∂â“µÕ∫∂Ÿ° 6 „π 8 Õ¬à“ß

20. „Àâ‡¥Á°¥Ÿ¿“æ ·≈â«∂“¡«à“ √Ÿª‰Àπ∫‘π‰¥â √Ÿª‰Àπ√âÕß‡À¡’¬« √Ÿª‰ÀπæŸ¥§ÿ¬‰¥â √Ÿª‰Àπ‡Àà“ √Ÿª‰Àπ«‘Ëß°äÕ∫ Ê ºà“π ∂â“µÕ∫∂Ÿ° 2 „π 5 À√◊Õ 4 „π 5 √Ÿª

21. ∂“¡‡¥Á°«à“ ®–∑”Õ¬à“ß‰√∂â“ÀπŸÀπ“« ®–∑”Õ¬à“ß‰√∂â“ÀπŸ‡Àπ◊ËÕ¬ ®–∑”Õ¬à“ß‰√∂â“ÀπŸÀ‘« ºà“π ∂â“µÕ∫∂Ÿ° 2 „π 3 Õ¬à“ß À√◊Õ 3 „π 3 Õ¬à“ß

22. ∂“¡‡¥Á°«à“ ∂â«¬‡Õ“‰«â∑”Õ–‰√ ‡°â“Õ’È‡Õ“‰«â∑”Õ–‰√ ¥‘π Õ‡Õ“‰«â∑”Õ–‰√

23. ºà“π ∂â“‡¥Á°«“ß®”π«π∂Ÿ°µâÕß·≈–∫Õ°‰¥â«à“¡’°âÕπ‰¡â°’Ë°âÕπ∫π°√–¥“… (1, 5)

24. ∫Õ°„Àâ‡¥Á°«“ß°âÕπ‰¡â∫π‚µä–; „µâ‚µä–; ¢â“ßÀπâ“©—π; ¢â“ßÀ≈—ß©—π ºà“π ∂â“∑”∂Ÿ° 4 „π 4 Õ¬à“ß

25. ∂“¡‡¥Á°«à“ ≈Ÿ°∫Õ≈§◊ÕÕ–‰√ ? ...∑–‡≈ ...‚µä– ...∫â“π ...°≈â«¬ ...¡à“π ...√—È« ...‡æ¥“π ºà“π ∂â“‡¥Á°„Àâ§«“¡À¡“¬„π≈—°…≥–°“√„™âß“π √Ÿª√à“ß ∑”¡“®“°

Õ–‰√À√◊Õ∫Õ°ª√–‡¿∑ (‡™àπ °≈â«¬‡ªìπº≈‰¡â ‰¡à„™à ’‡À≈◊Õß) ºà“π ∂â“µÕ∫∂Ÿ° 5 „π 8 Õ¬à“ß À√◊Õ 7 „π 8 Õ¬à“ß

26. ∂“¡‡¥Á°«à“∂â“¡â“µ—«„À≠à ÀπŸµ—«... ∂â“‰ø√âÕπ πÈ”·¢Áß... ∂â“¥«ßÕ“∑‘µ¬å¢÷Èπ‡«≈“°≈“ß«—π ¥«ß®—π∑√å¢÷Èπ‡«≈“... ºà“π ∂â“µÕ∫∂Ÿ° 2 „π 3

27. ‡¥Á°Õ“®®–‡°“–√“«À√◊Õ‡°“–°”·æß‡æ◊ËÕ™à«¬‡¥‘π¢÷Èπ∫—π‰¥ ‰¡à„™à§π®Ÿß ·≈–‰¡à§≈“π¢÷Èπ

28. ‡¥Á°µâÕß¢«â“ß∫Õ≈ÕÕ°‰ª‰°≈ 3 øÿµ „Àâ≈Ÿ°∫Õ≈Õ¬Ÿà„π√–¥—∫·¢π‡Õ◊ÈÕ¡∂÷ß (¡ÕßºŸâ∑¥ Õ∫)

29. ‡¥Á°µâÕß°√–‚¥¥ 2 ‡∑â“ ¢â“¡°√–¥“…∑’Ë¡’¢π“¥§«“¡°«â“ß 8 1/2 π‘È«

30. ∫Õ°„Àâ‡¥Á°‡¥‘πµàÕ‡∑â“‰ª¢â“ßÀπâ“ ‚¥¬„Àâπ‘È«‡∑â“·≈– âπ‡∑â“Àà“ß°—πª√–¡“≥ 1 π‘È« ºŸâ∑¥ Õ∫Õ“® “∏‘µ„Àâ‡¥Á°¥Ÿ°àÕπ (‡¥Á°µâÕß‡¥‘πµ‘¥µàÕ°—π 4 °â“«)

31. „π¢«∫ªï∑’Ë 2 ‡¥Á°ª°µ‘ª√–¡“≥§√÷ËßÀπ÷ËßÕ“®¡’≈—°…≥–‰¡à§àÕ¬√à«¡¡◊Õ

º≈°“√ —ß‡°µæƒµ‘°√√¡¢Õß‡¥Á°

·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å 35

¢Õ¢Õ∫§ÿ≥

·æ∑¬å∑’Ë‡¢â“√à«¡ª√–™ÿ¡

ª√–™ÿ¡/ —¡¡π“°“√ª√—∫ª√ÿß·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

≥ ÀâÕßª∑ÿ¡«—π ‚√ß·√¡‡Õ‡™’¬ °√ÿß‡∑æ¡À“π§√

«—π∑’Ë 20 - 21 °√°Æ“§¡ 2549

1. πæ.Õ¿‘™“µ‘ ‡®√‘≠∏√√¡ ÿ¢„® √æ.°√–∑ÿà¡·∫π ¡ÿ∑√ “§√

2. πæ.«√“«ÿ∏ °‘µµ‘«—≤π“°ÿ≈ √æ.¢Õπ·°àπ ¢Õπ·°àπ

3. πæ.‡∑’¬π™—¬ ∏“√‡°…¡ √æ.∑Õßº“¿Ÿ¡‘ °“≠®π∫ÿ√’

4. πæ.æ√™—¬ À™—¬√ÿàß‡√◊Õß √æ.πæ√—µπ√“™∏“π’ °√ÿß‡∑æ¡À“π§√

5. πæ.«‘√«‘™¬å ®‘πµ«√ √æ.π«¡‘π∑√å °√ÿß‡∑æ¡À“π§√

6. πæ.™—¬ ‘∑∏‘Ï §”· π √æ.‚ππ —ß ÀπÕß∫—«≈”¿Ÿ

7. æ≠.¡“√‘ “ »‘≈“∫ÿµ√ √æ.∫—«„À≠à π§√√“™ ’¡“

8. πæ.¡ÿ®≈‘π∑å ‡©≈‘¡æ√æß»å √æ.æ√–ª°‡°≈â“ ®—π∑∫ÿ√’

9. πæ.¿“≥ÿ¡“» ¢«—≠‡√◊Õπ √æ.·æ√à ·æ√à

10. πæ.«ÿ≤‘»—°¥‘Ï Õ“√’¬å«—≤π“ππ∑å √æ.≈–À“π∑√“¬ ∫ÿ√’√—¡¬å

11. πæ.«’√–¬ÿ∑∏ ‡ «‘«—≤πå √æ.»√’ ß§√“¡ π§√æπ¡

12. πæ.®—°√°ƒ…≥å ª√‘‚µ √æ. °≈π§√ °≈π§√

13. πæ. À— ‡À≈’Ë¬¡ ÿ«√√≥ ∂“∫—π ÿ¢¿“æ‡¥Á°·Ààß™“µ‘¡À“√“™‘π’ °√ÿß‡∑æ¡À“π§√

14. πæ.‰æ‚√®πå ∫ÿ≠≈—°…≥å»‘√‘ √æ.À“¥„À≠à ß¢≈“

15. πæ. —πµ‘ Õ—ß§≥“‚ ¿‘µ √æ.Õà“ß∑Õß Õà“ß∑Õß

16. πæ.‡Õ°√“™ Õ‘π∑√åÕÿ¥¡ √æ.Õÿ¥√∏“π’ Õÿ¥√∏“π’

17. πæ.«π√—°…å «—™√–»—°¥‘Ï»‘≈ªá §≥–·æ∑¬»“ µ√å ¡.‡™’¬ß„À¡à ‡™’¬ß„À¡à

36 ·π«∑“ß°“√√—°…“¿“«–‚æ√ß ¡Õß§—ËßπÈ” ”À√—∫·æ∑¬å

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PrasatwitthayaDDST = Denver developmental screening test EVD = External ventricular drainage HCP = Hydrocephalus ICP = Increased intracranial pressure IVH = Intraventricular hemorrhage