Izci Yusuf, Secer Halilibrahim, Akay Cemal, Gonul Engin
Department of Neurosurgery, Gulhane Military Medical Academy, Ankara, Turkey.
Neurol Res. 2009 Apr;31(3):234-7. doi: 10.1179/174313209X380973. Epub 2008 Nov 26.
Infection is a major complication and risk factor of cerebrospinal fluid (CSF) shunting procedures. Recently, antibiotic-impregnated shunt systems have been developed in an attempt to prevent or reduce the CSF infection. The aim of this study was to determine the efficacy of silver-impregnated polyurethane ventricular catheter for shunting of CSF in patients with infected hydrocephalus.
Seven patients who had hydrocephalus with high protein level and positive CSF culture underwent implantation of ventriculoperitoneal shunt with silver-impregnated polyurethane ventricular catheter. All of them experienced shunt failure previously due to infection. The Silverline ventricular catheter, which was connected to the Miethke gravity-assisted valve system and peritoneal catheter, was used in all patients. The mean follow-up period after operation was 14 months. Cerebrospinal fluid samples from the reservoir of the shunts were obtained at the end of the third month after operation in all patients.
The CSF protein level of the patients was reduced significantly, and the CSF culture became negative after shunt placement with silver-impregnated polyurethane ventricular catheters. The mean CSF silver (Ag) level was 0.51 ng/ml [parts per billion (ppb)], and blood Ag level was 3.65 ng/ml (ppb) at the first month after operation. No shunt obstruction or infection was observed in the follow-up period.
Silver-impregnated polyurethane ventricular catheters appear to be safe and well tolerated in patients who sustained infected hydrocephalus. Preliminary results suggest a complete improvement of infection. Longer follow-up and large number of patients are needed to more accurately assess the efficacy of these catheters.
感染是脑脊液分流术的主要并发症和危险因素。近来，已研发出含抗生素的分流系统，试图预防或减少脑脊液感染。本研究的目的是确定含银聚氨酯脑室导管在感染性脑积水患者脑脊液分流中的疗效。
7例脑脊液蛋白水平高且脑脊液培养呈阳性的脑积水患者接受了含银聚氨酯脑室导管的脑室腹腔分流术植入。他们此前均因感染经历过分流失败。所有患者均使用了连接到米特克重力辅助瓣膜系统和腹腔导管的银线脑室导管。术后平均随访期为14个月。所有患者在术后第三个月末从分流器储液囊获取脑脊液样本。
使用含银聚氨酯脑室导管进行分流术后，患者的脑脊液蛋白水平显著降低，脑脊液培养转为阴性。术后第一个月，脑脊液银（Ag）平均水平为0.51纳克/毫升[十亿分之一（ppb）]，血银水平为3.65纳克/毫升（ppb）。随访期间未观察到分流梗阻或感染。
含银聚氨酯脑室导管在感染性脑积水患者中似乎安全且耐受性良好。初步结果表明感染得到了完全改善。需要更长时间的随访和更多患者来更准确地评估这些导管的疗效。
