「active」在腦積水新定義中問題的解答

李小勇

搞清腦積水定義是認識各種腦脊液疾病的基礎理論。以往比較經典的腦積水定義有兩種類型，分別針對的是腦脊液和腦室（系統）的行為，如：1、Ventricular enlargement due to altered CSF flow or resorption （因為腦脊液流動或吸收的變化而引起的腦室擴大）；2、Hydrocephalus is a condition in which there is an accumulation of cerebrospinal fluid (CSF) within the brain.[1] （腦室內腦脊液蓄積的過程或狀態）（註：沒有敘述引起腦脊液蓄積的原因，根據上一定義或學者一般只是可以自然知道是腦脊液的循環受阻）。

Harold L Rekate教授，是美國鳳凰城聖若瑟醫院和醫學中心Barrow 神經病學研究所兒科神經科學部中一位行醫48年的教授，發表的題為「A Contemporary Definition and Classification of Hydrocephalus」的論述無疑對腦積水的概念具有很大的學術影響力，因為一直沒有被公認是好的腦積水定義。他提出的定義採用的是第一種類型：「hydrocephalus is an active distension of the ventricular system of the brain related to inadequate passage of CSF from its point of production within the ventricular system to its point of absorption into the systemic circulation」。可以直接翻譯成：「腦積水是腦室系統的主動擴張，原因是腦脊液通路不暢 」。這個翻譯沒有違背作者的原意或所表達的概念，但是讀者卻不知道「主動（active）」指的是「誰」的行為？是腦脊液的，還是腦室的？為什麼一個母語為英語的腦積水專家會發表如此的對象描述不明確的現象呢？說明在美國，至少可以說，美國也沒有很多深入於腦脊液學科研究的學者，也不是專職於腦脊液疾病的「業餘」學者。要說明這個「主動（active）」的所致，必須要首先理解這些術語之間的因果關係。腦積水定義，其實涉及到了三個概念：腦脊液，腦室（系統）即容納腦脊液的空間，以及作為固體部分的腦實質。

定義「Hydrocephalus is a condition in which there is an accumulation of cerebrospinal fluid (CSF) within the brain.[1] 」，所討論的是腦脊液和腦實質兩者，或腦脊液，腦室（系統）和腦實質三者之間的因果關係問題，如果將「主動（active）」植入此定義中，可以是「Hydrocephalus is a condition in which there is an active accumulation of cerebrospinal fluid (CSF) within the brain」的形式，表現的是相對於腦實質或相對於腦室而言的「主動（active）」，因此可以理解為腦室擴大是被動的（passive），而不是主動的。

此新的定義「「hydrocephalus is an active distension of the ventricular system of the brain.... 」中，按腦脊液循環原理分析，應討論的是腦室（系統）和腦實質兩者之間的關係，省去了腦脊液這個更早的「主動（active）」的概念或含義，所以，要理解或準確翻譯這個新的定義，還需要具備定義之外的一些腦脊液科基礎知識，其實如果將此定義加上腦脊液的內容，可能才更好理解「hydrocephalus is an active distension of（ CSF　in　）the ventricular system of the brain related to inadequate passage of CSF from its point of production within the ventricular system to its point of absorption into the systemic circulation」。翻譯成「腦積水是腦室系統內腦脊液的主動擴張，原因是腦脊液通路不暢 」，才更容易理解。

關於腦脊液主動擴張的概念，又是另一個「腦脊液是什麼」的新學術問題：腦脊液是物體，還是其內的成分？還是兩者兼有的概念？有待以後論述。如上討論，是本人的個人觀點，不對之處，歡迎指正和批評。

附： 腦積水的定義：其中的active是什麼意思？如何翻譯成漢語？

hydrocephalus is an active distension of the ventricular system of the brain related to inadequate passage of CSF from its point of production within the ventricular system to its point of absorption into the systemic circulation.

A Contemporary Definition and Classification of Hydrocephalus

Author links open overlay panelHarold L.RekateMD

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https://doi.org/10.1016/j.spen.2009.01.002Get rights and content

This review focuses on the problems related to defining hydrocephalus and on the development of a consensus on the classification of this common problem. Such a consensus is needed so that diverse research efforts and plans of treatment can be understood in the same context. The literature was searched to determine the definition of hydrocephalus and to identify previously proposed classification schemes. The historic perspective, purpose, and result of these classifications are reviewed and analyzed. The concept of the hydrodynamics of cerebrospinal fluid (CSF) as a hydraulic circuit is presented to serve as a template for a contemporary classification scheme. Finally, a definition and classification that include all clinical causes and forms of hydrocephalus are suggested. The currently accepted classification of hydrocephalus into 「communicating」 and 「noncommunicating」 varieties is almost 90 years old and has not been modified despite major advances in neuroimaging, neurosciences, and treatment outcomes. Despite a thorough search of the literature using computerized search engines and bibliographies from review articles and book chapters, I identified only 6 previous attempts to define and classify different forms of hydrocephalus. This review proposes the following definition for hydrocephalus: hydrocephalus is an active distension of the ventricular system of the brain related to inadequate passage of CSF from its point of production within the ventricular system to its point of absorption into the systemic circulation. Based on this definition (potential points of flow restriction) and on the view of the CSF system as a hydraulic circuit, a classification system is proposed. The acceptance of this proposed definition and classification schema would allow clinicians and basic scientists to communicate effectively, to share information and results, and to develop testable hypotheses.

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