Black P M, Hakim R, Bailey N O
Neurosurgical Service, Children's Hospital, Boston, Massachusetts.
Neurosurgery. 1994 Jun;34(6):1110-3. doi: 10.1227/00006123-199406000-00040.
Cerebrospinal fluid shunting is an important method of treating hydrocephalus. It sometimes has been difficult to achieve the optimum CSF pressure and ventricular size after shunt placement. Hydraulic and mechanical mismatching may occur, creating either overdrainage, as manifested by slit ventricle syndrome and/or subdural hygromas; or underdrainage, as manifested by a failure of the ventricles to change in size, with persistence of symptoms. A variable pressure valve (Codman-Medos Programmable Hakim valve system) has been developed to allow non-invasive increase or decrease in cerebrospinal fluid pressure in differentials of 10 mm of water within a range of 30-200 mm of water. This allows the neurosurgeon to adjust the pressure to the patient's particular clinical needs at any given moment. As part of a pilot study of the valve's safety, 13 patients in this center were treated with this programmable shunting system from October 1991 to January 1993. Twelve patients were over age 18 and one was younger than this. Six patients had previously been shunted with other valve systems, and the remaining seven had never been shunted before. The etiology of hydrocephalus included idiopathic normal pressure hydrocephalus (6 patients), aqueductal stenosis (3 patients), Chiari malformation (2 patients), meningitis (1 patient), and unknown etiology (1 patient). This paper describes the use of this valve in five illustrative cases; slit ventricle syndrome in an adult, chronic ventriculomegaly with aqueductal stenosis (2 cases), and idiopathic normal pressure hydrocephalus (2 cases). This programmable valve has been particularly useful in gradually decreasing ventricle size in idiopathic normal pressure hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)
脑脊液分流术是治疗脑积水的重要方法。分流术后有时难以达到最佳的脑脊液压力和脑室大小。可能会出现液压和机械不匹配的情况,导致过度引流,表现为裂隙脑室综合征和/或硬膜下积液;或引流不足,表现为脑室大小无变化且症状持续。已开发出一种可变压力阀(Codman - Medos可编程哈基姆阀系统),可在30 - 200毫米水柱范围内以10毫米水柱的差值无创地增加或降低脑脊液压力。这使神经外科医生能够在任何特定时刻根据患者的具体临床需求调整压力。作为该阀安全性初步研究的一部分,1991年10月至1993年1月,本中心的13名患者接受了这种可编程分流系统治疗。12名患者年龄超过18岁,1名患者年龄小于18岁。6名患者先前曾使用其他瓣膜系统进行分流,其余7名患者此前从未接受过分流。脑积水的病因包括特发性正常压力脑积水(6例)、导水管狭窄(3例)、Chiari畸形(2例)、脑膜炎(1例)和病因不明(1例)。本文描述了该瓣膜在五个典型病例中的应用;一名成人的裂隙脑室综合征、伴有导水管狭窄的慢性脑室扩大(2例)和特发性正常压力脑积水(2例)。这种可编程瓣膜在逐渐减小特发性正常压力脑积水患者的脑室大小方面特别有用。(摘要截取自250字)