Decq P, Blanquet A, Yepes C
Service de Neurochirurgie, Hôpital Henri Mondor, Créteil, France.
Acta Neurochir (Wien). 1995;136(1-2):92-4. doi: 10.1007/BF01411442.
The percutaneous placement of ventriculo-atrial (V-A) shunts for treatment of hydrocephalus has been previously reported by several authors as a simplified procedure. However, this technique did not avoid the use of a distal connector between the outlet catheter and the atrial one, which may lead to a disconnection. A technique of percutaneous V-A shunt insertion using a split sheath is described and illustrated with a series of 22 patients. The use of a split sheath eliminates any distal connector thus avoiding the risk of shunt disconnection and reducing the operating time. The average operating time was 31 min. This rapid procedure allowed us to operate on two of our patients under local anaesthesia. The correct placement of the atrial catheter tip was performed under fluoroscopic control and always confirmed by postoperative radiographs. Two incidents of carotid artery puncture were controlled by simple local compression without further consequences. The mean follow-up time is one year. All the patients' clinical conditions improved. We are encouraged to use this V-A technique more frequently as a method of choice in the treatment of adult hydrocephalus or when the peritoneal cavity is inaccessible in children. The use of a split sheath is successful in reducing the operating time and avoiding the use of a distal connector.
经皮置入脑室-心房（V-A）分流管治疗脑积水，此前已有多位作者报道这是一种简化手术。然而，该技术并未避免在引流导管与心房导管之间使用远端连接器，这可能导致分流管断开。本文描述了一种使用分体鞘管经皮插入V-A分流管的技术，并通过22例患者的系列病例进行说明。使用分体鞘管消除了所有远端连接器，从而避免了分流管断开的风险并缩短了手术时间。平均手术时间为31分钟。这种快速手术使我们能够在局部麻醉下为两名患者进行手术。心房导管尖端的正确位置在透视控制下完成，并始终通过术后X光片确认。两例颈动脉穿刺事件通过简单的局部压迫得到控制，未产生进一步后果。平均随访时间为一年。所有患者的临床状况均有改善。我们受到鼓舞，更频繁地使用这种V-A技术，将其作为治疗成人脑积水或儿童腹膜腔无法使用时的首选方法。使用分体鞘管成功缩短了手术时间并避免了使用远端连接器。
