Katano Hiroyuki, Karasawa Kunio, Sugiyama Naotake, Yamashita Nobuko, Ohkura Atsuhiko, Kamiya Ken
Department of Neurosurgery, Nagoya City Higashi General Hospital, Nagoya, Japan.
J Clin Neurosci. 2003 Sep;10(5):557-61. doi: 10.1016/s0967-5868(03)00125-5.
We describe our experience with Sophy programmable valve shunts, compared with Codman-Hakim programmable shunts in cases with normal pressure hydrocephalus (NPH) after subarachnoid hemorrhage (SAH). A total of 147 consecutive patients underwent 204 shunt implantations (102 Sophy valves, 51 Codman-Hakim valves, 51 nonprogrammable valves). Of these, 23 Sophy and 25 Codman-Hakim valves respectively were implanted into patients with NPH after SAH. Comparison of reprogramming rate and frequency in cases with NPH after SAH between Sophy and Codman-Hakim valves revealed similar reprogramming rates (65.2 vs. 64.0%) but a higher frequency with the former (1.70 vs. 1.08 times/person). The mean difference between initial and final pressure was 65.3+/-45.8mmH(2)O in cases with Sophy valves, and 25.0+/-14.1mmH(2)O with Codman-Hakim valves. The average period which was required to determine the final pressures with Sophy and Codman-Hakim valves were 56.5+/-45.0 days and 43.3+/-45.7 days, respectively. Total incidence of complications of Sophy and Codman-Hakim valve shunt systems in cases with NPH after SAH were 26.1% (6/23) and 16% (4/25), respectively. Total instances requiring shunt revision with Sophy valves in cases of NPH after SAH were 6 of 23 (26.1%), while for Codman-Hakim valves the figure was 2 of 25 (8.0%). Sophy, as well as Codman-Hakim programmable valve shunts, allow alteration of opening pressure after the implantation according to patients' conditions, which may contribute to reduction of revision. Similar reprogramming rates but lower frequency, and smaller difference between initial and final pressure in Codman-Hakim valves may be ascribed to finer pressure ranges and ease of reprogramming, which facilitates earlier reprogramming and decisions regarding final optimal opening pressure.
我们描述了在蛛网膜下腔出血（SAH）后正常压力脑积水（NPH）患者中使用Sophy可编程阀门分流器的经验，并与Codman-Hakim可编程分流器进行了比较。共有147例连续患者接受了204次分流器植入（102个Sophy阀门、51个Codman-Hakim阀门、51个非可编程阀门）。其中，分别有23个Sophy阀门和25个Codman-Hakim阀门植入了SAH后发生NPH的患者体内。比较SAH后NPH患者中Sophy阀门和Codman-Hakim阀门的重新编程率和频率，结果显示重新编程率相似（65.2%对64.0%），但前者的频率更高（1.70次/人对1.08次/人）。使用Sophy阀门的患者，初始压力与最终压力的平均差值为65.3±45.8mmH₂O，而使用Codman-Hakim阀门的患者为25.0±14.1mmH₂O。确定Sophy阀门和Codman-Hakim阀门最终压力所需的平均时间分别为56.5±45.0天和43.3±45.7天。SAH后NPH患者中Sophy和Codman-Hakim阀门分流系统的并发症总发生率分别为26.1%（6/23）和16%（4/25）。SAH后NPH患者中需要用Sophy阀门进行分流器翻修的总数为23例中的6例（26.1%），而Codman-Hakim阀门的这一数字为25例中的2例（8.0%）。Sophy以及Codman-Hakim可编程阀门分流器允许在植入后根据患者情况改变开放压力，这可能有助于减少翻修。Codman-Hakim阀门的重新编程率相似但频率较低，且初始压力与最终压力的差值较小，这可能归因于其更精细的压力范围和易于重新编程，这有利于更早地进行重新编程并决定最终的最佳开放压力。
