Freimann Florian Baptist, Schulz Matthias, Haberl Hannes, Thomale Ulrich-Wilhelm
Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Childs Nerv Syst. 2014 Apr;30(4):689-97. doi: 10.1007/s00381-013-2324-0. Epub 2013 Nov 22.
The advances in shunt valve technology towards modern adjustable differential pressure (DP) valves and adjustable gravitational assisted valves result in an increasing complexity of therapeutical options. Modern telemetric intracranial pressure (ICP) sensors may be helpful in their application for diagnostic purposes in shunt therapy. We present our first experiences on telemetric ICP-guided valve adjustments in cases with the combination of an adjustable DP valve and adjustable gravitational unit.
Four consecutive cases were evaluated in a retrospective review who had received a proGAV adjustable, gravitational assisted DP valve with secondary in-line implantation of an adjustable shunt assistant (proSA), together with a telemetric ICP sensor (Neurovent-P-tel) between December 2010 and June 2012 in our institution. The measured ICP values and the corresponding valve adjustments were analyzed in correlation with the clinical course and the cranial imaging of the patients.
No surgery-related complications were observed after implantation of the proSA and the telemetric ICP sensor additional to the proGAV. ICP values could actively be influenced by adjustments of the respective valve units. An increase of the position depending resistance of the proSA resulted in significant attenuated negative ICP values for the standing position, while adjustments of the proGAV could be detected not only in a supine position but also in a standing position. A clinical improvement could be achieved in all cases.
The combination of adjustability in the differential pressure valve and the gravitational unit reveals a complex combination which may be difficult to adapt only according to clinical information. Telemetric ICP-guided valve adjustments seem to be a promising tool as an objective measure according to different body positions. Further investigations are needed to select the patients for these costly implants.
分流阀技术向现代可调压差（DP）阀和可调重力辅助阀发展，导致治疗选择的复杂性增加。现代遥测颅内压（ICP）传感器可能有助于其在分流治疗诊断中的应用。我们介绍了在可调DP阀和可调重力装置联合使用的情况下，进行遥测ICP引导的阀门调整的初步经验。
对2010年12月至2012年6月期间在我们机构连续接受proGAV可调重力辅助DP阀并二次在线植入可调分流辅助装置（proSA）以及遥测ICP传感器（Neurovent-P-tel）的4例患者进行回顾性评估。分析测量的ICP值和相应的阀门调整，并与患者的临床病程和头颅影像学进行相关性分析。
在proGAV基础上植入proSA和遥测ICP传感器后，未观察到与手术相关的并发症。通过调整相应的阀门装置，可以积极影响ICP值。proSA位置依赖性阻力增加导致站立位时ICP负值显著减小，而proGAV的调整不仅在仰卧位，而且在站立位都能检测到。所有病例均实现了临床改善。
压差阀和重力装置的可调性相结合显示出一种复杂的组合，仅根据临床信息可能难以适应。遥测ICP引导的阀门调整似乎是一种有前景的工具，可作为根据不同体位的客观测量方法。需要进一步研究以选择适合这些昂贵植入物的患者。
