Catalán G, Bilbao G, Pomposo I, Aurrecoechea J, Garibi J
Servicio de Neurocirugía, Hospital de Cruces, Plaza de Cruces, s/n. E-48903 Barakaldo, Vizcaya.
Rev Neurol. 2000;31(12):1136-42.
Programmable valves are a possible solution in cases of excessive or insufficient draining.
To report our experience with these shunts and clarify concepts.
We have implanted 125 Codman-Medos programmable devices in 118 patients. The most frequent indication was secondary hydrocephalus, particularly due to obstruction by a tumour, and primary hydrocephalus. They were also used in cases of benign intracranial hypertension, CSF fistulas and arachnoid cysts. Most valves were inserted frontally, under antibiotic prophylaxis.
Excluding patients with a follow-up of less than three months, the average follow-up was 14.63 +/- 9.07 months, with clinical improvement in 80%. There was 0% mortality in relation to surgery. The initial average pressure was 121.84 +/- 24.74 mmH2O and after 52 reprogrammings done in 36 (30%) of the patients, the final average pressure was 124.96 +/- 30.58 mmH2O. Reprogramming was done for the management of symptoms and to avoid subdural hygromas. We have observed no clinical signs of unprogramming. There were 29 complications which were treated by reprogramming in 7 cases and surgically in the remainder.
We recommend frontal insertion, with a long peritoneal catheter, mainly in patients with hydrocephalus secondary to stenosis of the aqueduct of Sylvius, benign intracranial hypertension, after head injury and Arnold-Chiari malformation. The initial pressure is difficult to determine but tends to be average or high. Reprogramming is particularly useful in the treatment of subdural hygromas. We have observed no clinical signs of unprogramming. Complications tend to be due to surgical technique rather than the particular shunt used.
对于引流过多或不足的情况，可编程阀门是一种可能的解决方案。
报告我们使用这些分流器的经验并阐明相关概念。
我们为118例患者植入了125个Codman-Medos可编程装置。最常见的适应症是继发性脑积水，尤其是由于肿瘤阻塞所致，以及原发性脑积水。它们也用于良性颅内高压、脑脊液瘘和蛛网膜囊肿的病例。大多数阀门从前额插入，同时给予抗生素预防。
排除随访时间少于三个月的患者，平均随访时间为14.63±9.07个月，80%的患者临床症状改善。手术相关死亡率为0%。初始平均压力为121.84±24.74 mmH₂O，在36例（30%）患者进行52次重新编程后，最终平均压力为124.96±30.58 mmH₂O。重新编程是为了控制症状并避免硬膜下积液。我们未观察到未编程的临床迹象。有29例并发症，其中7例通过重新编程治疗，其余通过手术治疗。
我们建议主要在患有导水管狭窄继发脑积水、良性颅内高压、头部受伤后以及Arnold-Chiari畸形的患者中，采用前额插入并使用长的腹腔导管。初始压力难以确定，但往往为平均或较高水平。重新编程在治疗硬膜下积液方面特别有用。我们未观察到未编程的临床迹象。并发症往往是由于手术技术而非所使用的特定分流器。
