Sahuquillo Juan, Rosas Katiuska, Calvo Helena, Alcina Aloma, Gándara Dario, López-Bermeo Diego, Poca Maria-Antonia
Department of Neurosurgery, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Neurotrauma and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
J Clin Med. 2021 Mar 15;10(6):1210. doi: 10.3390/jcm10061210.
Most patients with hydrocephalus are still managed with the implantation of a cerebrospinal fluid (CSF) shunt in which the CSF flow is regulated by a differential-pressure valve (DPV). Our aim in this review is to discuss some basic concepts in fluid mechanics that are frequently ignored but that should be understood by neurosurgeons to enable them to choose the most adequate shunt for each patient. We will present data, some of which is not provided by manufacturers, which may help neurosurgeons in selecting the most appropriate shunt. To do so, we focused on the management of patients with idiopathic "normal-pressure hydrocephalus" (iNPH), as one of the most challenging scenarios, in which the combination of optimal technology, patient characteristics, and knowledge of fluid mechanics can significantly modify the surgical results. For a better understanding of the available hardware and its evolution over time, we will have a second look at the design of the first DPV and the reasons why additional devices were incorporated to control for shunt overdrainage and its related complications. We try to persuade the reader that a clear understanding of the physical concepts of the CSF and shunt dynamics is key to understand the pathophysiology of iNPH and to improve its treatment.
大多数脑积水患者仍通过植入脑脊液（CSF）分流器来治疗，其中脑脊液流动由压差阀（DPV）调节。本综述的目的是讨论一些流体力学的基本概念，这些概念经常被忽视，但神经外科医生应该理解，以便为每位患者选择最合适的分流器。我们将展示一些制造商未提供的数据，这些数据可能有助于神经外科医生选择最合适的分流器。为此，我们重点关注特发性“正常压力脑积水”（iNPH）患者的管理，这是最具挑战性的情况之一，在这种情况下，最佳技术、患者特征和流体力学知识的结合可以显著改善手术效果。为了更好地理解现有的硬件及其随时间的演变，我们将再次审视第一个压差阀的设计，以及为何要加入其他装置来控制分流器过度引流及其相关并发症。我们试图说服读者，清楚理解脑脊液和分流动力学的物理概念是理解iNPH病理生理学并改善其治疗的关键。
