Development and Clinical Application of Anti-Slit Ventricular Catheter.

目前脑积水的治疗仍以依赖分流器的脑积水停搏为手术干预的目标，开发一种新的分流系统，使脑脊液引流在更生理的情况下得到控制，是一个迫切需要解决的问题。本研究的目的是开发一种分流导管系统，以防止分流依赖状态导致心室系统改变为狭缝样构型。本课题分为大鼠胎儿脑积水实验模型和硅胶脑室模型的研制及实验应用两部分。前者在大鼠胎儿中发生6-AN诱导的脑积水，并放置胎儿-脑室=母体-腹膜分流器。实验结果揭示了继发性导水渠阻塞导致孤立性第四脑室并幕上脑室系统变为裂隙状的可能机制。为了证明这一机制，后来进行了实验研究。该脑室系统模拟模型由两个侧脑室、第三脑室和第四脑室组成，并有单独的连接通路，即Monro孔、Sylvius输水管、脊髓中央管等。一侧侧脑室置入常规脑室管（Pudenz脑室导管），另一侧侧脑室置入反狭缝脑室导管分流。同时，每根导管在脑脊液引流时监测双侧脑室压力。结果证实，当使用反缝心室导管时，脉压保存良好。本课题圆满完成，证明了抗狭缝脑室导管的有效性，并对分流后狭缝样脑室和孤立脑室的生理机制进行了分析。

It is an urgent problem to develop a new shunt system in which CSF drainage can be controlled in more physiological condition, as far as the present status of hydrocephalus treatment remains in shunt dependent arrested hydrocephalus as the goal of the surgical intervention. The purpose of this research is to develop a shunt catheter system which prevent the ventricular system to change to slit-like configulation as a result of shunt-dependent condition.The research project was devided into two parts, one with an experimental model of rat-fetus hydrocephalus and the other with development and experimental use of silicone ventricular model. In the former, 6-AN induced hydrocephalus was developed in rat fetuses and fetus-ventriculo=mater-peritoneal shunt was placed. The experiment results revealed some suggestive mechanism for isolated fourth ventricle due to secondary obstruction of the aqueduct together with supra-tentorial ventricular system changed to slit-like. To prove this mechanism, the later experimental study was developed. This simulation model of the ventricular system was consisted of two lateral ventricles, third and fourth ventricles with individual connective pathways, i. e. foramen of Monro, aqueduct of Sylvius, central canal of the spinal cord and so on. One lateral ventricle was placed a regular ventricular tube (Pudenz ventricular catheter) and the other was shunted with an anti-slit ventricualr catheter. At the same time, bilateral intraventricular pressure monitoring was performed during CSF draingae by each catheter. The results confirmed well preserved pulse pressure when the anti-slit ventricular catheter was used.The research project was satisfactorily completed with this proof of efficacy of anti-slit ventricular catheter together with the analysis of physiological mechanisms of post-shunt slit-like ventricle and isolated ventricles.