Perforation holes in ventricular catheters-is less more?
Perforation holes in ventricular catheters-is less more?
复制标题
DOI：
10.1007/s00381-009-1055-8
复制
发表时间：
2010-06-01
影响因子：
1.4
通讯作者：
Sprung, Christian
中科院分区：
文献类型：
--
作者：
Thomale, Ulrich W.;Hosch, Henning;Sprung, Christian
梗阻是脑脊液分流失败的常见原因。近端梗阻功能障碍的危险因素是脑室导管位置不佳和脑室裂隙状。评估了一种新的脑室导管设计，以降低梗阻的风险。回顾了70例闭塞的脑室导管的组织病理学检查。实现了一种具有6个穿孔的新的脑室导管设计。在实验装置中，这些导管与常规导管(16孔、Miethke、Eesculap)在流体静压水平从14到2 cmH(2)O下使用墨水研究和流速进行比较。对55例脑室裂隙状脑积水患者植入六孔导尿管。组织学评估显示梗阻组织涉及43-60%的脑室外组织，包括胶质细胞、结缔组织和炎性细胞。在血流特性研究中，16孔导管显示只有近端穿孔具有功能相关性。对于六孔导管，所有穿孔都与剩余储备容量有关。然而，6个穿孔和16个穿孔之间的血流速度没有显着差异。55例患者置入6孔导管，平均随访15+/-9个月。共植入12根导管，显示总存活率为77.4%。在狭窄的脑室，我们认为位于组织内的导管穿孔可能是脑脊液分流阻塞的危险因素。当导管能够以足够的精度植入时，在具有相同流动特征的导管中穿孔的数量较少可能会降低这种风险。
Obstruction is a common cause of cerebrospinal fluid (CSF) shunt failure. Risk factors for proximal obstructive malfunction are suboptimal ventricular catheter positioning and slit-like ventricles. A new ventricular catheter design to decrease risk of obstruction was evaluated.A review of histopathological tissue investigation from occluded ventricular catheters (n = 70) was performed. A new ventricular catheter design was realized with six perforation holes. These catheters were compared to regular catheters (16 holes, Miethke, Aesculap) for flow characteristics using ink studies and flow velocity at hydrostatic pressure levels from 14 to 2 cmH(2)O in an experimental setup. The six-hole catheters were implanted in hydrocephalic patients with slit-like ventricles (n = 55). A follow-up was performed to evaluate the need of catheter revisions.Histological evaluation showed that obstructive tissue involved 43-60% extraventricular tissue, including gliosis, connective and inflammatory cells. In flow characteristic studies, the 16-hole catheters showed that only proximal perforations are of functional relevance. For six-hole catheters, all perforations were shown to be relevant with remaining reserve capacity. Flow velocity however showed no significant differences between six and 16 perforations. The six-hole catheter was implanted in 55 patients with a mean follow-up period of 15 +/- 9 months. A total of 12 catheters were explanted, revealing an overall survival proportion of 77.4%.In narrow ventricles, we assume that catheter perforations that are located also in the tissue might be a risk for CSF shunt obstruction. Fewer amounts of perforations in the catheters with equal flow features might decrease this risk when catheters can be implanted with adequate precision.