Development and Clinical Application of Anti-Slit Ventricular Catheter.

鉴于目前脑积水的治疗现状仍以分流依赖型阻滞性脑积水为手术干预目标，开发一种能够在更生理条件下控制脑脊液引流的新分流系统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，以防止分流依赖条件导致脑室系统改变为狭缝状结构。研究项目分为两部分，一部分是大鼠胎脑积水的实验模型，另一部分是硅胶脑室模型的研制和实验应用。前者造成胎鼠6-AN诱发的脑积水，进行胎脑-脑室-腹膜分流术。实验结果揭示了导水管继发梗阻并伴有幕上脑室系统裂隙样改变所致孤立性第四脑室的一些可能机制。为了证明这一机制，开展了后来的实验研究。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，各有独立的连接通路，即Monro孔、Sylvius导水管、脊髓中央管等。一侧脑室放置规则的脑室导管(Pudenz脑室导管)，另一侧脑室采用反缝隙脑室导管分流。同时，在脑脊液引流时用每根导管监测双侧脑室内压。实验结果证实了使用反缝隙脑室导管时脉压保持良好，验证了反缝隙脑室导管的有效性，并对分流后缝隙状脑室和隔离脑室的生理机制进行了分析，圆满完成了研究项目。

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.