Deininger Martin H, Weyerbrock Astrid
Department of Neurosurgery, University of Freiburg Medical School, Breisacher Str. 64, D-79106 Freiburg, Germany.
Acta Neurochir (Wien). 2009 Jun;151(6):705-9; discussion 709. doi: 10.1007/s00701-009-0291-8. Epub 2009 Apr 1.
In the subgroup of bedridden hydrocephalic patients with ventriculo-peritoneal shunts and gravitational valves, we occasionally observed persisting hydrocephalic complaints even when mechanical or infection-related obstruction was excluded.
To investigate the cause of these hydrocephalic symptoms, in vitro and in vivo analyses were used to determine valve opening, intra-abdominal and hydrostatic pressure of an Aesculap-Miethke 10/40 cm H2O gravitational valve at different angles of upper body and head inclination.
Since hydrostatic pressure is lacking, the resulting intra-ventricular pressures are shown to peak up to 27 cm H2O in supine patients with head, but not upper body inclined.
We conclude that in the subgroup of bedridden patients with ventriculo-peritoneal shunts and gravitational valves, upright posture is a prerequisite for proper cerebrospinal fluid drainage.
在患有脑室 - 腹腔分流术和重力瓣膜的卧床脑积水患者亚组中，我们偶尔会观察到即使排除了机械性或感染相关的梗阻，仍存在持续的脑积水症状。
为了研究这些脑积水症状的原因，采用体外和体内分析方法来确定Aesculap - Miethke 10/40 cm H₂O重力瓣膜在不同上身和头部倾斜角度下的瓣膜开放情况、腹腔内压力和静水压力。
由于缺乏静水压力，在头部倾斜但上身不倾斜的仰卧患者中，所产生的脑室内压力高达27 cm H₂O。
我们得出结论，在患有脑室 - 腹腔分流术和重力瓣膜的卧床患者亚组中，直立姿势是脑脊液正常引流的先决条件。
