腰大池腹腔分流.pptVIP

St. Marianna University School of Medicine Department of Neurosurgery Kotaro Oshio M.D. PhD. The preparation and practical surgical technique of lumboperitoneal shunts腰大池-腹腔分流术前准备及临床手术方法 Topics Historical background of LP shunting LP分流的历史背景 Benefits and complications of LP shunting Experience in using LP shunting LP 分流的优势及并发症——使用经验 Indication of LP shunting Diagnosis iNPH accordance with the guidelines LP分流的适应症——自发性正常颅压脑积水的诊断 Video seminar The detailed procedure of LP shunt 手术视频——LP分流的具体步骤 Why LP shunt was not standard?And Why LP shunt now? 为什么LP分流曾经不是标准而现在广泛使用？ First introduction of LP shunt was 1950’s. For treatment of hydrocephalus. LP分流最早于1950年推出，以治疗脑积水 Simple technique 但技术很简单 Most neurosurgeon hesitate to do LP shunt. Because “Too much complication” then. 很多的神经外科大夫由于术后太多的并发症，而放弃LP分流 Improvement 改良 Material Equipment 材料和设备 “Diagnosis” 诊断 History of LP shunt LPLP 分流的历史 1950’s first introduction Material : polyethylene 聚乙烯 - X induce arachnoiditis and scoliosis 引起蛛网膜炎和脊柱侧凸 1975 Selman et.al. Material : Silicone 硅树脂 - O less arachnoiditis and scoliosis Complication :　LP shunt ＞ VP shunt 　postural overdrainage : SDFC SDH Etc. 　 Diagnosis Treatment difficult ! favorable indication: communicating hydrocephalus 给诊断和治疗带来困难 Improvement of the material 材料的改进 Unfortunately, NO adjustable valve ! NO CT scan, NO MRI ! 没有可调压阀门，没有CT，没有MRI Accurate diagnosis less complication in shunt surgery 准确诊断、并发症少 Before making guideline of iNPH Hebb and Cusimano Neurosurgery: 49, No. 5, 2001 Shunting INPH systematic review : Suggest : Criteria for iNPH is not unified (没有统一的标准 iNPH) significant improvement: only 29% (range 10-100%) Complications occurred in 38% (range, 5–100%) Required additio