von der Brelie Christian, Meier Ullrich, Gräwe Alexander, Lemcke Johannes
Department of Neurosurgery, Neurovascular Centre, Unfallkrankenhaus Berlin, Berlin, Germany.
J Neurosci Rural Pract. 2016 Jan-Mar;7(1):48-54. doi: 10.4103/0976-3147.172159.
Sophisticated shunt valves provide the possibility of pressure adjustment and antisiphon control but have a higher probability of valve dysfunction especially in a posthemorrhagic setting. The aim of the present study is to analyze the clinical outcome of patients with shunt dependent posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage (SAH) in order to identify patients who would benefit from a simple differential pressure valve.
From 2000 to 2013, 547 patients with aneurysmatic SAH were treated at our institution, 114 underwent ventricular shunt placement (21.1%). 47 patients with available pre- and post-operative computed tomography scans, and an available follow-up of minimum 6 months were included. In order to measure the survival time which a nonprogrammable differential pressure valve would have had in an individual patient we defined the initial equalized shunt survival time (IESS). IESS is the time until surgical revisions of fixed differential pressure or flow-regulated valves for the treatment of over- or under-drainage as well as re-programming of adjustable valves due to over- or under-drainage.
Twenty patients were treated with fixed differential pressure valves, 15 patients were treated with flow-regulated valves, and 12 underwent ventriculoperitoneal (VP) shunt placement with differential pressure valves assisted by a gravitational unit. Patients who reacted with remarkable changes of the ventricular width after the insertion of external ventricular drainage (EVD), before shunt placement, showed a significantly longer IESS.
Decline of the ventricular width after EVD placement was a predictor for successful VP shunt therapy in the later course of disease. Possibly, this could allow identifying patients who benefit from a simple differential pressure valve or a flow-regulated valve, and thus could possibly avoid valve-associated complications of a programmable valve in the later course of disease.
先进的分流阀提供了压力调节和抗虹吸控制的可能性，但尤其是在出血后情况下，阀门功能障碍的概率更高。本研究的目的是分析动脉瘤性蛛网膜下腔出血（SAH）后分流依赖型出血后脑积水患者的临床结局，以确定能从简单的压差阀中获益的患者。
2000年至2013年，我院共治疗547例动脉瘤性SAH患者，其中114例行脑室分流术（21.1%）。纳入47例术前和术后均有计算机断层扫描且随访时间至少6个月的患者。为了测量不可编程压差阀在个体患者中的存活时间，我们定义了初始平衡分流存活时间（IESS）。IESS是指因引流过多或过少而对固定压差或流量调节阀进行手术修正以及因引流过多或过少而对可调阀进行重新编程的时间。
20例患者使用固定压差阀治疗，15例患者使用流量调节阀治疗，12例患者在重力装置辅助下使用压差阀进行脑室腹腔（VP）分流术。在放置分流管前插入外部脑室引流（EVD）后，脑室宽度有显著变化的患者显示IESS明显更长。
EVD放置后脑室宽度的下降是疾病后期VP分流术成功治疗的预测指标。这可能有助于识别能从简单压差阀或流量调节阀中获益的患者，从而可能避免疾病后期可编程阀相关的并发症。
