Skip to main content
Erschienen in: Der Nervenarzt 6/2004

01.06.2004 | Originalien

Schwerkraftventile beim idiopathischen Normaldruckhydrozephalus

Eine prospektive Studie von 60 Patienten

verfasst von: PD Dr. U. Meier

Erschienen in: Der Nervenarzt | Ausgabe 6/2004

Einloggen, um Zugang zu erhalten

Zusammenfassung

Zielsetzung

Sind bei Patienten mit Normaldruckhydrozephalus hydrostatische Ventile konventionellen Differenzialdruckventilen bezüglich der postoperativen Behandlungsergebnisse und möglicher Komplikationen überlegen?

Patienten und Methode

Von 1997 bis 2002 wurden im Unfallkrankenhaus Berlin-Marzahn 60 Patienten mit einem idiopathischen Normaldruckhydrozephalus durch Implantation eines hydrostatischen Ventils (Miethke-Dual-Switch-Ventil) operativ behandelt.

Ergebnisse

Von den Patienten weisen 33% einen sehr guten, 33% einen guten und je 17% einen befriedigenden bzw. schlechten Krankheitsverlauf ein Jahr nach der Shunt-Operation auf. Die ventilabhängigen und -unabhängigen Komplikationen (Katheterdislokalisationen, Ventilinfektionen, Unter- bzw. Überdrainagen) sind mit 20% noch relativ hoch. Die Druckstufe des Miethke-Dual-Switch-Ventils korreliert nicht mit den postoperativen Behandlungsergebnissen!

Schlussfolgerung

Nach unseren Erfahrungen sind bei Patienten mit einem idiopathischen Normaldruckhydrozephalus hydrostatische Ventile (Miethke-Dual-Switch-Ventil) konventionellen Differenzialdruckventilen und verstellbaren Ventilen ohne zusätzliche Schwerkrafteinheit hinsichtlich der postoperativen Behandlungsergebnisse und möglicher Komplikationen überlegen.
Literatur
1.
Zurück zum Zitat Aguas-Valiente J, Martinez-Manas R, Ferrer-Rodriguez E (1997) Diagnostic and therapeutic criteria of adults normal-pressure hydrocephalus. Descriptive multicenter national study. Rev Neurol 25:27–36PubMed Aguas-Valiente J, Martinez-Manas R, Ferrer-Rodriguez E (1997) Diagnostic and therapeutic criteria of adults normal-pressure hydrocephalus. Descriptive multicenter national study. Rev Neurol 25:27–36PubMed
2.
Zurück zum Zitat Aschoff A (1994) In-vitro-Testung von Hydrocephalus-Ventilen. Habilitationsschrift, Universität Heidelberg Aschoff A (1994) In-vitro-Testung von Hydrocephalus-Ventilen. Habilitationsschrift, Universität Heidelberg
3.
Zurück zum Zitat Aschoff A, Benesch C, Kremer P et al. (1995) Overdrainage and shunt-technology. A critical comparison of programmable, hydrostatic and variable-resistance-valve and flow-reducing devices. Childs Nerv Syst 11:193–202PubMed Aschoff A, Benesch C, Kremer P et al. (1995) Overdrainage and shunt-technology. A critical comparison of programmable, hydrostatic and variable-resistance-valve and flow-reducing devices. Childs Nerv Syst 11:193–202PubMed
4.
Zurück zum Zitat Bech RA, Waldemar G, Gjerris F et al. (1999) Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir 141:633–639CrossRef Bech RA, Waldemar G, Gjerris F et al. (1999) Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir 141:633–639CrossRef
5.
Zurück zum Zitat Benzel EC, Pelletier AL, Levy PG (1990) Communicating hydrocephalus in adults: Prediction of outcome after ventricular shunting procedures. Neurosurgery 26:655–660PubMed Benzel EC, Pelletier AL, Levy PG (1990) Communicating hydrocephalus in adults: Prediction of outcome after ventricular shunting procedures. Neurosurgery 26:655–660PubMed
6.
Zurück zum Zitat Boon AJW, Thans JTJ, Delwel EJ et al. (1999) Dutch normal pressure hydrocephalus study. The role of cerebrovascular disease. J Neurosurg 90:221–226PubMed Boon AJW, Thans JTJ, Delwel EJ et al. (1999) Dutch normal pressure hydrocephalus study. The role of cerebrovascular disease. J Neurosurg 90:221–226PubMed
7.
Zurück zum Zitat Borgesen SE (1984) Conductance to outflow of CSF in normal pressure Hydrocephalus. Acta Neurochir 71:1–15 Borgesen SE (1984) Conductance to outflow of CSF in normal pressure Hydrocephalus. Acta Neurochir 71:1–15
8.
Zurück zum Zitat Caruso R, Cervoni L, Vitale AM et al. (1997) Idiopathic normal-pressure hydrocephalus in adults: Result of shunting correlated with clinical findings in 18 patients and review of the literature. Neurosurg Rev 20:104–107PubMed Caruso R, Cervoni L, Vitale AM et al. (1997) Idiopathic normal-pressure hydrocephalus in adults: Result of shunting correlated with clinical findings in 18 patients and review of the literature. Neurosurg Rev 20:104–107PubMed
9.
Zurück zum Zitat Czosnyka Z, Czosnyka M, Richards HK et al. (2002) Laboratory testing of hydrocephalus shunts—conclusion of the UK shunt evaluation programme. Acta Neurochir 144:525–538CrossRef Czosnyka Z, Czosnyka M, Richards HK et al. (2002) Laboratory testing of hydrocephalus shunts—conclusion of the UK shunt evaluation programme. Acta Neurochir 144:525–538CrossRef
10.
Zurück zum Zitat Decq P, Barat JL, Duplessis E et al. (1995) Shunt failure in adult hydrocephalus: flow controlled shunt versus differential pressure shunts—a cooperative study in 289 patients. Surg Neurol 43:333–339PubMed Decq P, Barat JL, Duplessis E et al. (1995) Shunt failure in adult hydrocephalus: flow controlled shunt versus differential pressure shunts—a cooperative study in 289 patients. Surg Neurol 43:333–339PubMed
11.
Zurück zum Zitat Drake JM, Kestle JRW, Milner R et al. (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–305PubMed Drake JM, Kestle JRW, Milner R et al. (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–305PubMed
12.
Zurück zum Zitat Frim DM, Goumnerova LC (2000) In vivo intracranial pressure dynamics in patients with hydrocephalus treated by shunt placement. J Neurosurg 92:927–32PubMed Frim DM, Goumnerova LC (2000) In vivo intracranial pressure dynamics in patients with hydrocephalus treated by shunt placement. J Neurosurg 92:927–32PubMed
13.
Zurück zum Zitat Fukuhara T, Luciano MG, Brant CL et al. (2001) Effects of ventriculoperitoneal shunt removal on cerebral oxygenation and brain compliance in chronic obstructive hydrocephalus. J Neurosurg 94:573–581PubMed Fukuhara T, Luciano MG, Brant CL et al. (2001) Effects of ventriculoperitoneal shunt removal on cerebral oxygenation and brain compliance in chronic obstructive hydrocephalus. J Neurosurg 94:573–581PubMed
14.
Zurück zum Zitat Grumme T, Kolodziejczyk D (1995) Kraniale, zerebrale und neuropädiatrische Chirurgie. Komplikationen in der Neurochirurgie, Bd 2. Blackwell, Berlin, S 534–540 Grumme T, Kolodziejczyk D (1995) Kraniale, zerebrale und neuropädiatrische Chirurgie. Komplikationen in der Neurochirurgie, Bd 2. Blackwell, Berlin, S 534–540
15.
Zurück zum Zitat Hakim CA (1985) The physics and physicopathology of the hydraulic complex of the central nervous system. The mechanics of hydrocephalus and normal pressure hydrocephalus. Dissertation, Massachusetts Institute of Technology Hakim CA (1985) The physics and physicopathology of the hydraulic complex of the central nervous system. The mechanics of hydrocephalus and normal pressure hydrocephalus. Dissertation, Massachusetts Institute of Technology
16.
Zurück zum Zitat Hanlo PW, Cinalli G, Vandertop P et al. (2003) Treatment of hydrocephalus by the European Orbis Sigma Valve II survey: a multicenter 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99:52–57PubMed Hanlo PW, Cinalli G, Vandertop P et al. (2003) Treatment of hydrocephalus by the European Orbis Sigma Valve II survey: a multicenter 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99:52–57PubMed
17.
Zurück zum Zitat Hebb AO, Cusimano MD (2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186PubMed Hebb AO, Cusimano MD (2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186PubMed
18.
Zurück zum Zitat de Jong DA, Delwel EJ, Avezaat CJJ (2000) Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochir 142:24 de Jong DA, Delwel EJ, Avezaat CJJ (2000) Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochir 142:24
19.
Zurück zum Zitat Kiefer M, Eymann R, Meier U (2002) Five years experience with gravitational shunts in chronic hydrocephalus of adults. Acta Neurochir 144:755–767CrossRef Kiefer M, Eymann R, Meier U (2002) Five years experience with gravitational shunts in chronic hydrocephalus of adults. Acta Neurochir 144:755–767CrossRef
20.
Zurück zum Zitat Kosteljanetz M, Nehen AM, Kaalund J (1990) Cerebrospinal fluid outflow resistance measurements in the selection of patients for shunt surgery in the normal pressure hydrocephalus syndrom: a controlled trial. Acta Neurochir 104:48–53 Kosteljanetz M, Nehen AM, Kaalund J (1990) Cerebrospinal fluid outflow resistance measurements in the selection of patients for shunt surgery in the normal pressure hydrocephalus syndrom: a controlled trial. Acta Neurochir 104:48–53
21.
Zurück zum Zitat Krauss JK, Droste DW, Vach W et al. (1996) Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular und deep white matter lesions. Neurosurgery 39:292–299PubMed Krauss JK, Droste DW, Vach W et al. (1996) Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular und deep white matter lesions. Neurosurgery 39:292–299PubMed
22.
Zurück zum Zitat Lee EJ, Hung YC, Chang CH et al. (1998) Cerebral blood flow velocity and vasomotor reactivity before and after shunting surgery in patients with normal pressure hydrocephalus. Acta Neurochir 140:599–605CrossRef Lee EJ, Hung YC, Chang CH et al. (1998) Cerebral blood flow velocity and vasomotor reactivity before and after shunting surgery in patients with normal pressure hydrocephalus. Acta Neurochir 140:599–605CrossRef
23.
Zurück zum Zitat Meier U (1998) Der intrathekale Infusionstest als Entscheidungshilfe zur Shunt-Operation beim Normaldruckhydrozephalus. Habilitation, Medizinische Fakultät (Charité) der Humboldt-Universität zu Berlin Meier U (1998) Der intrathekale Infusionstest als Entscheidungshilfe zur Shunt-Operation beim Normaldruckhydrozephalus. Habilitation, Medizinische Fakultät (Charité) der Humboldt-Universität zu Berlin
24.
Zurück zum Zitat Meier U (2002) The grading of normal pressure hydrocephalus. Biomed Engin 47:54–58 Meier U (2002) The grading of normal pressure hydrocephalus. Biomed Engin 47:54–58
25.
Zurück zum Zitat Meier U, Bartels P (2001) The importance of the intrathecal infusion test in the diagnostic of normal pressure hydrocephalus. Eur Neurol 46:178–186CrossRefPubMed Meier U, Bartels P (2001) The importance of the intrathecal infusion test in the diagnostic of normal pressure hydrocephalus. Eur Neurol 46:178–186CrossRefPubMed
26.
Zurück zum Zitat Meier U, Kintzel D (2002) Clinical experiences with different valve systems in patients with normal-pressure hydrocephalus: evaluation of the Miethke dual-switch valve. Childs Nerv Syst 18:288–294PubMed Meier U, Kintzel D (2002) Clinical experiences with different valve systems in patients with normal-pressure hydrocephalus: evaluation of the Miethke dual-switch valve. Childs Nerv Syst 18:288–294PubMed
27.
Zurück zum Zitat Meier U, Miethke C (2003) Predictors of outcome in patients with normal pressure hydrocephalus. J Clin Neurosci 10:453–459CrossRefPubMed Meier U, Miethke C (2003) Predictors of outcome in patients with normal pressure hydrocephalus. J Clin Neurosci 10:453–459CrossRefPubMed
28.
Zurück zum Zitat Meier U, Zeilinger FS, Kintzel D (1999) Signs, symptoms and course of disease in normal pressure hydrocephalus in relation to cerebral atrophy. Acta Neurochir 141:1039–1048CrossRef Meier U, Zeilinger FS, Kintzel D (1999) Signs, symptoms and course of disease in normal pressure hydrocephalus in relation to cerebral atrophy. Acta Neurochir 141:1039–1048CrossRef
29.
Zurück zum Zitat Meier U, Zeilinger FS, Kintzel D (1999) Diagnostic in normal pressure hydrocephalus: a mathematical model for determination of the ICP-dependent resistance and compliance. Acta Neurochir 141:941–948CrossRef Meier U, Zeilinger FS, Kintzel D (1999) Diagnostic in normal pressure hydrocephalus: a mathematical model for determination of the ICP-dependent resistance and compliance. Acta Neurochir 141:941–948CrossRef
30.
Zurück zum Zitat Meier U, Kiefer M, Bartels P (2002) The ICP-dependency of resistance to cerebrospinal fluid outflow: a new mathematical method for CSF-parameter calculation in a model with H-Tx rats. J Clin Neurosci 9:58–63CrossRefPubMed Meier U, Kiefer M, Bartels P (2002) The ICP-dependency of resistance to cerebrospinal fluid outflow: a new mathematical method for CSF-parameter calculation in a model with H-Tx rats. J Clin Neurosci 9:58–63CrossRefPubMed
31.
Zurück zum Zitat Meier U, Kiefer M, Sprung C (2002) The Miethke Dual-Switch valve in patients with normal pressure hydrocephalus. Neurosurg Q 12:114–121CrossRef Meier U, Kiefer M, Sprung C (2002) The Miethke Dual-Switch valve in patients with normal pressure hydrocephalus. Neurosurg Q 12:114–121CrossRef
32.
Zurück zum Zitat Meier U, Kiefer M, Sprung C (2004) Evaluation of the Dual-Switch-Valve in patients with normal pressure hydrocephalus. Surg Neurol 61:119–128CrossRefPubMed Meier U, Kiefer M, Sprung C (2004) Evaluation of the Dual-Switch-Valve in patients with normal pressure hydrocephalus. Surg Neurol 61:119–128CrossRefPubMed
33.
Zurück zum Zitat Meier U, Kiefer M, Sprung C (2003) Normal-pressure hydrocephalus: pathology, pathophysiology, diagnostics, therapeutics and clinical course. PVV Science Publications, Ratingen Meier U, Kiefer M, Sprung C (2003) Normal-pressure hydrocephalus: pathology, pathophysiology, diagnostics, therapeutics and clinical course. PVV Science Publications, Ratingen
34.
Zurück zum Zitat Meier U, Paris S, Gräwe A et al. (2003) Is there a correlation between postoperative results and change in ventricular volume after shunt placement? A study of 60 cases of idiopatic normal pressure hydrocephalus. Neuroradiology 45:377–380CrossRefPubMed Meier U, Paris S, Gräwe A et al. (2003) Is there a correlation between postoperative results and change in ventricular volume after shunt placement? A study of 60 cases of idiopatic normal pressure hydrocephalus. Neuroradiology 45:377–380CrossRefPubMed
35.
Zurück zum Zitat Miethke C, Affeld K (1994) A new valve for the treatment of hydrocephalus. Biomed Tech 39:181–187 Miethke C, Affeld K (1994) A new valve for the treatment of hydrocephalus. Biomed Tech 39:181–187
36.
Zurück zum Zitat Miyake H, Ohta T, Kajimoto Y et al. (2000) New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using a microflowmeter. Technical note. J Neurosurg 92:181–187 Miyake H, Ohta T, Kajimoto Y et al. (2000) New concept for the pressure setting of a programmable pressure valve and measurement of in vivo shunt flow performed using a microflowmeter. Technical note. J Neurosurg 92:181–187
37.
Zurück zum Zitat Pollack IF, Albright AL, Adelson PD et al. (1999) A randomized, controlled study of a programmable shunt valve versus a conventionel valve for patients with hydrocephalus. Neurosurgery 45:1399–1411PubMed Pollack IF, Albright AL, Adelson PD et al. (1999) A randomized, controlled study of a programmable shunt valve versus a conventionel valve for patients with hydrocephalus. Neurosurgery 45:1399–1411PubMed
38.
Zurück zum Zitat Raftopoulos C, Massager N, Baleriaux D et al. (1996) Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery 38:51–59PubMed Raftopoulos C, Massager N, Baleriaux D et al. (1996) Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery 38:51–59PubMed
39.
Zurück zum Zitat Richards HK, Seeley HM, Pickard JD (2000) Shunt revisions: Data from the UK shunt registry. Eur J Pediatr Surg 10(Suppl 1):59 Richards HK, Seeley HM, Pickard JD (2000) Shunt revisions: Data from the UK shunt registry. Eur J Pediatr Surg 10(Suppl 1):59
40.
Zurück zum Zitat Rohde V, Mayfrank L, Ramakers VT et al. (1998) Four-year experience with the routine use of the programmable Hakim valve in management of children with hydrocephalus. Acta Neurochir 140:1127–1134CrossRef Rohde V, Mayfrank L, Ramakers VT et al. (1998) Four-year experience with the routine use of the programmable Hakim valve in management of children with hydrocephalus. Acta Neurochir 140:1127–1134CrossRef
41.
Zurück zum Zitat Sindou M, Guyotat-Pelissou I, Chidiac A et al. (1993) Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Acta Neurochir 121:135–139 Sindou M, Guyotat-Pelissou I, Chidiac A et al. (1993) Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Acta Neurochir 121:135–139
42.
Zurück zum Zitat Sotelo J, Rubalcava MA, Gomez-Liata S (1995) A new shunt for hydrocephalus that relies on CSF production rather than on ventricular pressure: initial clinical experiences. Surg Neurol 43:324–331PubMed Sotelo J, Rubalcava MA, Gomez-Liata S (1995) A new shunt for hydrocephalus that relies on CSF production rather than on ventricular pressure: initial clinical experiences. Surg Neurol 43:324–331PubMed
43.
Zurück zum Zitat Sprung C, Miethke C, Trost HA et al. (1996) The dual-switch valve. Childs Nerv Syst 12:573–581PubMed Sprung C, Miethke C, Trost HA et al. (1996) The dual-switch valve. Childs Nerv Syst 12:573–581PubMed
44.
Zurück zum Zitat Takeuchi T, Kasahara E, Iwasaki M et al. (2000) Indications for shunting in patients with idiopathic normal pressure hydrocephalus presenting with dementia and brain atrophy (atypical idiopathic normal pressure hydrocephalus). Neurol Med Chir (Tokyo) 40:38–47 Takeuchi T, Kasahara E, Iwasaki M et al. (2000) Indications for shunting in patients with idiopathic normal pressure hydrocephalus presenting with dementia and brain atrophy (atypical idiopathic normal pressure hydrocephalus). Neurol Med Chir (Tokyo) 40:38–47
45.
Zurück zum Zitat Tsunoda A, Ebato M, Maruki C (2002) Clinical experience of a Dual switch valve in the management of hydrocephalus: post-operative changes in ventricular size and intra-ventricular pressure. Jpn J Neurosurg (Tokyo) 11:592–597 Tsunoda A, Ebato M, Maruki C (2002) Clinical experience of a Dual switch valve in the management of hydrocephalus: post-operative changes in ventricular size and intra-ventricular pressure. Jpn J Neurosurg (Tokyo) 11:592–597
46.
Zurück zum Zitat Vanneste JAL (2000) Diagnosis and managment of normal-pressure hydrocephalus. J Neurol 247:5–14CrossRefPubMed Vanneste JAL (2000) Diagnosis and managment of normal-pressure hydrocephalus. J Neurol 247:5–14CrossRefPubMed
47.
Zurück zum Zitat Zemack G, Romner B (2000) Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg 92:941–948PubMed Zemack G, Romner B (2000) Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg 92:941–948PubMed
Metadaten
Titel
Schwerkraftventile beim idiopathischen Normaldruckhydrozephalus
Eine prospektive Studie von 60 Patienten
verfasst von
PD Dr. U. Meier
Publikationsdatum
01.06.2004
Erschienen in
Der Nervenarzt / Ausgabe 6/2004
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-004-1695-6

Weitere Artikel der Ausgabe 6/2004

Der Nervenarzt 6/2004 Zur Ausgabe

Mitteilungen der DGPPN

Mitteilungen der DGPPN