Craven Claudia L, Toma Ahmed K, Watkins Laurence D
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, United Kingdom.
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, United Kingdom.
J Clin Neurosci. 2017 Mar;37:91-95. doi: 10.1016/j.jocn.2016.11.004. Epub 2016 Nov 24.
The ever present need to balance over drainage with under drainage in hydrocephalus has required innovations including adjustable valves with antigravity devices. These are activated in the vertical position to prevent siphoning. We describe a group of bedridden patients who presented with unexplained under drainage caused by activation of antigravity shunt components produced by peculiar head/body position. Retrospective single centre case series of hydrocephalus patients, treated with ventriculo-peritoneal (VP) shunt insertion between April 2014 - February 2016. These patients presented with clinical and radiological under drainage syndrome. Medical notes were reviewed for clinical picture and outcome. Radiological studies were reviewed assessing shunt placement and ventricular size. Seven patients presented with clinical and radiological under drainage syndrome. A consistent posturing of long term hyper-flexion of the neck whilst lying supine was observed. All patients had similar shunt construct (adjustable Miethke ProGAV valve and shunt assistant anti-gravity component). In each of those patients a hypothesis was formulated that neck flexion was activating the shunt assistance anti-gravity component in supine position. Five patients underwent shunt revision surgery removing the shunt assistant device from the cranium and adding an anti-gravity component to the shunt system at the chest. One had the shunt assistant completely removed and one patient was managed conservatively with mobilisation. All patients had clinical and radiological improvement. Antigravity shunt components implanted cranially in bedridden hydrocephalus patients will produce underdrainage due to head flexion induced anti-gravity device activation. In these patients, anti-gravity devices should be placed at the chest. Alternatively, special nursing attention should be paid to head-trunk angle.
在脑积水治疗中，始终需要平衡过度引流和引流不足的问题，这就催生了包括带有反重力装置的可调阀门在内的创新技术。这些阀门在垂直位置被激活，以防止虹吸现象。我们描述了一组卧床患者，他们出现了不明原因的引流不足，这是由特殊的头部/身体姿势激活反重力分流组件所致。这是一项对2014年4月至2016年2月期间接受脑室-腹腔（VP）分流术的脑积水患者进行的回顾性单中心病例系列研究。这些患者出现了临床和影像学上的引流不足综合征。我们查阅了病历以了解临床表现和治疗结果。回顾了影像学研究以评估分流器位置和脑室大小。7名患者出现了临床和影像学上的引流不足综合征。观察到所有患者在仰卧时均有长期颈部过度屈曲的一致姿势。所有患者都有类似的分流器构造（可调式Miethke ProGAV阀门和分流辅助反重力组件）。在每例患者中，我们都提出了一个假设，即颈部屈曲在仰卧位激活了分流辅助反重力组件。5例患者接受了分流器翻修手术，从颅骨上移除了分流辅助装置，并在胸部的分流系统中增加了一个反重力组件。1例患者的分流辅助装置被完全移除，1例患者通过活动进行保守治疗。所有患者的临床和影像学表现均有改善。对于卧床的脑积水患者，颅骨植入的反重力分流组件会因头部屈曲导致反重力装置激活而产生引流不足。对于这些患者，反重力装置应放置在胸部。或者，应特别注意头部与躯干的角度。
