Yamamoto Shinji, Ohno Kikuo, Aoyagi Masaru, Ichinose Shizuko, Hirakawa Kimiyoshi
Department of Neurosurgery, School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Childs Nerv Syst. 2002 Feb;18(1-2):19-25. doi: 10.1007/s00381-001-0532-5. Epub 2001 Dec 6.
Three cases with late complications and nine cases without late complications are presented to demonstrate the long-term results of ventriculoperitoneal (V-P) shunting, particularly those concerning degradation and mineral deposits of shunt catheters.
Plain X-rays were taken in every case to detect any calcification. The catheters removed following late complications were examined in a scanning electron microscope (SEM). Spectroscopy and conventional histology were also performed.
Routine histology, spectroscopy, and SEM revealed that the mineral deposits consisted of hydroxyapatite. Plain X-ray and operative findings showed that the most extensive calcification was present in the neck, where the catheters were subject to heavy mechanical stress. No calcification was detected on catheters that did not contain barium particles. Our findings indicate that mechanical stress contributes to the process of degradation, and that barium sulfate admixed with silicone during the manufacturing process might accelerate late complications owing to the formation of cracks in the catheters and by enhancing the nucleation rate.
本文报告3例出现晚期并发症的病例和9例未出现晚期并发症的病例，以展示脑室腹腔分流术（V-P分流术）的长期效果，尤其是与分流导管降解和矿物质沉积相关的效果。
对每个病例进行X线平片检查以检测是否存在钙化。对出现晚期并发症后取出的导管进行扫描电子显微镜（SEM）检查。还进行了光谱分析和传统组织学检查。
常规组织学、光谱分析和扫描电子显微镜检查显示，矿物质沉积由羟基磷灰石组成。X线平片和手术结果表明，钙化最严重的部位在颈部，此处导管承受较大的机械应力。不含钡颗粒的导管未检测到钙化。我们的研究结果表明，机械应力促进了降解过程，并且在制造过程中与硅酮混合的硫酸钡可能由于导管中形成裂缝以及提高成核速率而加速晚期并发症的发生。
