Kiefer M, Eymann R, Steudel W I
Neurochirurgische Universitätsklinik, Homburg/Saar, Germany.
Nervenarzt. 2002 Oct;73(10):972-81. doi: 10.1007/s00115-002-1389-x.
The recently defined term "longstanding overt ventriculomegaly in adults" (LOVA) describes a unique entity of chronic occlusive hydrocephalus. The experiences so far using conventional DP valves were not encouraging because of a high percentage of overdrainage. The objective was to evaluate whether gravitational shunts could be used for this condition with an acceptable overdrainage risk. Twenty-three macrocephalic adults aged 17-72 years suffered from chronic progressive hydrocephalic conditions. They received two different types of gravitational shunt. Follow-up ranged from 6 months to 75 months. Only two patients presented small subdural effusions postoperatively, and only one required additional treatment for that. Eighty-two percent were shunt responders. Ventricular size was only marginally reduced in 22 of the 23 patients. There was no correlation between clinical benefit and the reduction in ventricular size. Gravitational shunts clearly have the potency for safe treatment of LOVA, significantly reducing the risk of overdrainage over conventional valves, and may be considered an equivalent alternative to third ventriculostomy.
最近定义的术语“成人长期显性脑室扩大”（LOVA）描述了一种独特的慢性梗阻性脑积水实体。由于过度引流的比例较高，迄今为止使用传统分流阀的经验并不令人鼓舞。目的是评估重力性分流器是否可用于这种情况，且具有可接受的过度引流风险。23名年龄在17至72岁的巨头症成年人患有慢性进行性脑积水病症。他们接受了两种不同类型的重力性分流器。随访时间为6个月至75个月。术后仅有两名患者出现少量硬膜下积液，其中只有一名需要为此接受额外治疗。82%的患者对分流有反应。23名患者中有22名脑室大小仅略有缩小。临床获益与脑室大小缩小之间没有相关性。重力性分流器显然有安全治疗LOVA的潜力，与传统分流阀相比，可显著降低过度引流的风险，并且可被视为第三脑室造瘘术的等效替代方法。
