M. Ağahan ÜNLÜ, Bermans J. ISKANDAR, Habibullah DOLGUN, Gökalp SİLAV

Orta basınçlı akım kontrollü ve basınç kontrollü serebrospinal sıvı şant sistemleri, uzun süreli dinamik inceleme

Hidrosefali tedavisinde bir çok yöntem kullanılsada en sık kullanılan yöntemlerden biri şant uygulamalarıdır. Her nekadar biriken BOS'nın sistem dışına atılması amaçlansada henüz ideal çalışmaları sağlanamamıştır. Yapılan bu deneyin amacı hidrosefali tedavisinde sık karşılaşılan durumlardan biri olan şant fonksiyon bozukluklarını daha iyi aydınlatmaktır. Karşılaşılan en önemli fonksiyon bozukluklarından biri olan aşırı drenaj, ayakta durur pozisyon göz önünde bulundurularak taklit edilmeye çalışılmış ve bir düzenekle valv sistemleri 10 smH2O basınca distal kateterde oluşturulan 40 smH2O hidrostatik basınç eklenerek denenmiştir. Sonuçlarda valv sistemlerinin akım hızlarının başlangıçta birbirlerinden farklı olabilecekleri ve zaman içinde farklılıklar, azalmalar gösterebilecekleri kanıtlanmıştır. Bu özelliklerin hidrosefalin hastalarda şant uygulamalarına ve hastaların takiplerine yararlı olabileceği düşünülmüştür.

Shunting in the treatment of hydrocephalus

Although many therapies have been used in the treatment of Hydrocephalus, shunting is the therapy most widely used. The main purpose of shunting is to divert excessive CSF (Cerebro Spinal Fluid) to other systems. So far, the ideal conditions for this treatment have not been discovered. In this experiment, we attempted to clarify the mechanism of shunt dysfunction, which causes major problems in the management of Hydrocephalus by shunting. Overdrainage that occurs in an erect position and is one of the most common complications of shunting was simulated using a simple valve and catheter setup with 10 cmH2O proximal and 40 cmH2O distal hydrostatic pressure on the valve. Our results suggest that differences in initial pressure may be encountered even in the same valve group and that pressure may decrease to a certain level after a few days. It would be useful to keep in mind these results when planning a shunt for a hydrocéphalie patient and during the follow-up period.

PDF

___

1. Drake J M., S.-R.C., The shunt book. Vol. August. 1995: Blackvvell Science.
2. Aronyk, K., The history and classification of hydrocephalus. Neurosurgery Clinics of North America, ed. M.M. Winn RH . Vol. 4. 1993: Philadelphia, PA: W.B Saunders Company. 599-609.
3. Mori, K., Current concept of hydrocephalus: evolution of new classifications. Childs Nerv Syst 1995: 11: 523-31.
4. Mori, K., Hydrocephal us—revision of its definition and classification with special reference to "intractable infantile hydrocephalus". Childs Nerv Syst, 1990: 6: 198-204.
5. Mori, K., et al., Classification of hydrocephalus and outcome of treatment. Brain Dev, 1995: 17: 338-48.
6. Aschoff, A., et al., The scientific history of hydrocephalus and its treatment. Neurosurg Rev, 1999: 22: 67-93; discussion 94-5.
7. Blount, J.P., J.A. Campbell, and S.J. Haines, Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin N Am, 1993: 4: 633-56.
8. Drake, ).M. and J. Kestle, Determining the best cerebrospinal fluid shunt valve design: the pediatric valve design trial [see comments]. Neurosurgery, 1996: 38: 604-7.
9. Drake, J.M., et al., Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery, 1998: 43: 294-303.
10. Kestle, J., R. Milner, and J. Drake, The shunt design trial: variation in surgical experience did not influence shunt survival. Pediatr Neurosurg, 1999: 30: 283-7.
11. Gilkes, C.E., A.J. Steers, and R.A. Minns, A classification of CSF shunt malfunction [İn Process Citation], EurJ Pediatr Surg, 1999:9 (Suppl 1): 19- 22.
12. Czosnyka, Z., et al., Hydrodynamic properties of hydrocephalus shunts. Açta Neurochir Suppl, 1998: 71: 334-9.
13. Drake, J.M., G. Tenti, and S. Sivalsganathan, Computer modeling of siphoning for CSF shunt design evaluation. Pediatr Neurosurg, 1994: 21: 6-15.
14. Fox, J.L., D.C. McCullough, and R.C. Green, Cerebrospinal fluid shunts: an experimental comparison of flovv rates and pressure values in various commercial systems. J Neurosurg, 1972: 37: 700-5.