Freimann Florian Baptist, Luhdo Marie-Luise, Rohde Veit, Vajkoczy Peter, Wolf Stefan, Sprung Christian
Department of Neurosurgery, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Germany, 37099, Göttingen, Germany,
Acta Neurochir (Wien). 2014 Jul;156(7):1351-6. doi: 10.1007/s00701-014-2076-y. Epub 2014 May 4.
The in-line combination of adjustable differential pressure valves with fixed gravitational units is increasingly recommended in the literature. The spatial positioning of the gravitational unit is thereby decisive for the valve opening pressure. We aimed at providing data on factors contributing to primary overdrainage and underdrainage of cerebrospinal fluid (CSF), with special attention paid to the implantation angle of the gravitational unit.
Weretrospectively analyzed the postoperative course of 376 consecutive patients who received a ventriculoperitoneal shunt with a proGAV valve. The incidence of both primary CSF overdrainage and underdrainage was correlated with the implantation angle of the gravitational unit in regard to the Frankfurt horizontal plane and the patients' general parameters.
Primary overdrainage was found in 41 (10.9 %) patients. Primary underdrainage was found in 113 (30.1 %) patients. A mean deviation of 10° (±7.8) for the gravitational unit in regard to the vertical line to the Frankfurt horizontal plane was found. In 95 % of the cases the deviation was less than 25°. No significant correlation between the implantation angle and the incidence of overdrainage or underdrainage of CSF was found. The patients' age and having single hydrocephalus entities were identified as factors significantly predisposing patients to overdrainage or underdrainage.
The implantation of the gravitational unit of the proGAV valve within a range of at least 10° in regard to the vertical line to the Frankfurt horizontal plane does not seem to predispose patients to primary overdrainage or underdrainage in ventriculoperitoneal shunting. The plane may serve as a useful reference for the surgeon's orientation.
文献中越来越多地推荐将可调节压差阀与固定重力装置进行串联组合。重力装置的空间定位对阀门开启压力起决定性作用。我们旨在提供有关导致脑脊液（CSF）原发性引流过多和引流不足的因素的数据，特别关注重力装置的植入角度。
我们回顾性分析了376例连续接受带有proGAV阀的脑室腹腔分流术患者术后的病程。将原发性脑脊液引流过多和引流不足的发生率与重力装置相对于法兰克福水平面的植入角度以及患者的一般参数进行关联分析。
41例（10.9%）患者出现原发性引流过多。113例（30.1%）患者出现原发性引流不足。发现重力装置相对于与法兰克福水平面垂直的直线平均偏差为10°（±7.8）。在95%的病例中，偏差小于25°。未发现植入角度与脑脊液引流过多或引流不足的发生率之间存在显著相关性。患者的年龄以及患有单一脑积水类型被确定为使患者易发生引流过多或引流不足的显著因素。
proGAV阀的重力装置相对于与法兰克福水平面垂直的直线在至少10°范围内植入，似乎不会使患者在脑室腹腔分流术中易发生原发性引流过多或引流不足。该平面可为外科医生的定位提供有用的参考。
