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可调节重力抗虹吸装置在脑积水分流术中的应用

The integrated application of adjustable gravitational-valve proSA in hydrocephalus ventriculo-peritoneal shunt
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摘要 目的探讨可调节重力抗虹吸装置在脑积水分流术中使用的安全性及有效性。方法纳入初次诊断脑积水(17例)或侧脑室腹腔分流术(ventriculo-peritoneal shunt,VPS)后出现过度引流(6例)的患者,植入可调节重力抗虹吸装置,定期随访记录患者分流阀压、影像学脑室变化及临床症状变化等。结果17例初次诊断脑积水患者植入可调压分流阀(商品名:proGAV)+可调节重力抗虹吸装置(商品名:proSA)后,其proGAV阀门和proSA阀门平均压分别为(92.4±3.0)mmH_(2)O和(23.0±0.8)cmH_(2)O,头部影像示Evan指数由术前0.34±0.01降为0.28±0.01;额角直径/同一水平颅骨内板间径比(frontal horns/internal diameter,FH/ID)由术前0.44±0.01降为0.36±0.01,差异均具有统计学意义(P<0.05),提示术后脑室系统明显缩小;17例患者术后临床症状双下肢乏力及尿失禁均明显改善(3例昏迷患者除外)。另6例首次未植入抗重力阀的脑积水患者VPS分流术后出现头晕恶心呕吐等过度引流症状,遂植入proSA,其Codman阀门压由术前(170.0±9.5)mmH_(2)O降低为(120.0±8.4)mmH_(2)O,差异有统计学意义(P<0.05);头部影像示额枕/颅径比(fronto-occipital horn ratio,FOHR)由0.23±0.02升至0.37±0.01,差异有统计学意义(P<0.05),提示脑室系统由裂隙样形态恢复至基本正常;6例患者过度引流临床症状明显缓解。结论在临床初诊脑积水或VPS术后过度引流等复杂脑积水患者中植入可调节重力抗虹吸装置调控脑脊液引流是安全且有效的。 Objective The aim of this study was to explore the feasibility and effectiveness of adjustable gravitational-valve proSA treatment for hydrocephalus or hydrocephalus post-ventriculo-peritoneal shunt(VPS)related overdrainage.Methods Hydrocephalus or hydrocephalus post-VPS related overdrainage patients were included.Then adjustable gravitational-valve proSA was implanted.Valve pressure,ventricle image change and clinical outcome were recorded and analyzed during follow-up period.Results Seventeen cases first diagnosed hydrocephalus patients received VPS with implantation of differential pressure valve(proGAV)and adjustable gravitational-valve(proSA).The mean proGAV valve and proSA valve pressure was(92.4±3.0)mmH_(2)O and(23.0±0.8)cmH_(2)O.The Evan index decreased from pre-operative 0.34±0.01 to post-operative 0.28±0.01(P<0.05).The frontal horns/internal diameter(FH/ID)index decreased from pre-operative 0.44±0.01 to post-operative 0.36±0.01(P<0.05).The ventricular system narrowed obviously after VPS.The weakness of both lower limbs and urinary incontinence were significantly improved after VPS(except three coma patients).Six hydrocephalus patients suffered overdrainage after first VPS without anti-siphon valve in other hospital with clinical symptoms.The Codman valve pressure decreased from pre-operative(170.0±9.5)mmH_(2)O to post-operative(120.0±8.4)mmH_(2)O after implanted adjustable gravitational-valve(proSA)in our hospital.The frontooccipital horn ratio(FOHR)increased gradually from pre-operative 0.23±0.02 to post-operative 0.37±0.01(P<0.05),with no difference with normal FOHR value 0.37.The ventricular system re-enlarged obviously from overdrainage slit shape into normal shape.Dizzies,headache and nausea were completely relieved after proSA valve implantation.Conclusions The integrated application of adjustable gravitational-valve proSA in hydrocephalus or hydrocephalus related overdrainage is an effective and safe method for cerebral spinal fluid(CSF)management.
作者 章昌明 宣若恒 杨超 郭少雷 刘金龙 ZHANG Changming;XUAN Ruoheng;YANG Chao;GUO Shaolei;LIU Jinlong(Department of Neurosurgery,The first affiliated hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处 《中国神经精神疾病杂志》 CAS CSCD 北大核心 2022年第6期342-346,共5页 Chinese Journal of Nervous and Mental Diseases
关键词 脑积水 侧脑室腹腔分流术(VPS) 过度引流 可调节重力抗虹吸装置(proSA) Hydrocephalus Ventriculo-peritoneal shunt(VPS) Overdrainage Adjustable gravitational-valve(proSA)
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