Foltz E L, Blanks J, Meyer R
Department of Neurological Surgery, University California Irvine Medical Center.
Surg Neurol. 1993 Mar;39(3):210-7. doi: 10.1016/0090-3019(93)90185-4.
Hydrocephalic patients with years of ventricle shunts may be disabled by shunt overdrainage. Gravity-induced upright CSF shunt flow produces this overdrainage with abnormally low, upright ICP. Consequently, the concept of a normal level of zero ICP, which ventricle shunts must mimic, was developed. For 4.5 years, this concept has been applied in hydrocephalus patients by using a Siphon Control Device as a Zero Pressure Device in ventricle shunts. The results in 56 patients, including 42 overdrainage problems, were assessed by clinical grading, ICP record analyses, and computed tomographic (CT) ventricle size comparisons. All patients ultimately achieved satisfactory clinical results. This occurred in 80% of the patients on the first insertion. Adjustment of the vertical level of the Zero Pressure Device was necessary in 20%. The optimum clinical result correlated with an upright ICP of -66 mm of H2O. This postoperative ICP correlated within 4 mm of the Zero Pressure Device placement below vertex. Ventricle size correlated poorly with clinical grade and normal ICP. Only 73% of slit ventricles enlarged by 16.5 months. The need to mimic normal upright ICP by maintaining a normal level of zero upright ICP in shunted patients is supported by these results.
患有脑室分流多年的脑积水患者可能会因分流过度引流而致残。重力诱导的直立脑脊液分流导致这种过度引流，同时伴有异常低的直立颅内压。因此，提出了脑室分流必须模拟的正常颅内压为零的概念。4.5年来，通过在脑室分流中使用虹吸控制装置作为零压力装置，这一概念已应用于脑积水患者。通过临床分级、颅内压记录分析和计算机断层扫描（CT）脑室大小比较，对56例患者（包括42例过度引流问题）的结果进行了评估。所有患者最终均取得了满意的临床效果。80%的患者在首次植入时即出现这种情况。20%的患者需要调整零压力装置的垂直高度。最佳临床效果与直立颅内压为-66mm水柱相关。术后颅内压与零压力装置置于头顶下方的距离在4mm范围内相关。脑室大小与临床分级和正常颅内压的相关性较差。只有73%的裂隙脑室在16.5个月时扩大。这些结果支持了在分流患者中通过维持正常的直立颅内压为零来模拟正常直立颅内压的必要性。
