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首页> 美国卫生研究院文献>Journal of Clinical Medicine >Considerations in the Use of Gravitational Valves in the Management of Hydrocephalus. Some Lessons Learned with the Dual-Switch Valve
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Considerations in the Use of Gravitational Valves in the Management of Hydrocephalus. Some Lessons Learned with the Dual-Switch Valve

机译：在脑积水管理中使用引力阀的考虑因素。使用双开关阀学习的一些教训

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In the past decade, there has been a clear trend towards better outcomes in patients with hydrocephalus, especially those with normal pressure hydrocephalus (NPH). This is partly due to the availability of more sophisticated hardware and a better understanding of implants. However, there is little evidence to show the superiority of a specific type of valve over another. The most commonly reported consequence of hydrodynamic mismatch is shunt over-drainage. Simple differential pressure valves, with a fixed opening pressure or even adjustable valves, lead to non-physiologic intraventricular pressure (IVP) as soon as the patient moves into an upright posture. These valves fail to maintain IVP within physiological limits due to the changes in hydrostatic pressure in the drainage system. To solve this problem more complex third-generation hydrostatic valves have been designed. These gravitational devices aim to reduce flow through a shunt system when the patient is upright but there are important technical differences between them. Here we review the main characteristics of the Miethke® Dual-Switch valve, which includes two valve chambers arranged in parallel: a low-opening pressure valve, designed for working in the supine position, and a second high-opening pressure valve, which starts working when the patient assumes the upright position. This paper specifies the main advantages and drawbacks of this device and provide a series of recommendations for its use. The discussion of this specific gravitational valve allows us to emphasize the importance of using gravitational control in implanted shunts and some the caveats neurosurgeons should take into consideration when using gravitational devices in patients with hydrocephalus. The correct function of any gravitational device depends on adequate device implantation along the vertical body axis. Misalignment from the vertical axis equal to or more than 45° might eliminate the beneficial effect of these devices.
机译：在过去的十年中，脑积水患者的更好成果具有明显的趋势，尤其是具有正常压力脑积水（NPH）的患者。这部分是由于更复杂的硬件和更好地了解植入物的可用性。然而，几乎没有证据表明特定类型的阀门在另一个阀门的优越性。流体动力学错配的最常见后果是分流过排水。简单的差压阀，具有固定的开口压力甚至可调节阀门，一旦患者移动到直立姿势，就会导致非生理的脑室压力（IVP）。由于排水系统中的静水压力的变化，这些阀门未能在生理限度内维持IVP。为了解决这个问题，已经设计了更复杂的第三代静水阀。当患者直立时，这些引力装置旨在通过分流系统减少流量，但它们之间存在重要的技术差异。在这里，我们审查了Miethke®双开关阀的主要特性，包括两个平行排列的两个阀室：开启压力阀，设计用于在仰卧位工作，以及第二高开口压力阀开始当患者承担直立位置时工作。本文规定了该设备的主要优点和缺点，并为其使用提供了一系列建议。对该特定的引力阀的讨论使我们能够强调在植入分流器中使用引力控制的重要性，并且当使用脑积水患者的引力装置时，应考虑一些警告神经外部。任何重力器件的正确功能取决于沿垂直体轴的适当装置植入。垂直轴的未对准等于或大于45°可能会消除这些器件的有益效果。

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