（优质课件）腰大池腹腔分流.pptVIP

* Fixed at 4 points, Arm stand * * * * * lumber catheter insert 10cm to caudal. * Lumbo-Peritoneal Catheter Set (Sophysa) * The tips of lumbar puncture Direction for Tuohy Needle Median approach (MA): Interspinous process 1st choice Paramedian approach: MA point 1cm lateral and 1cm caudal option Height : L3/4 – L4/5 * Placement of lumbar catheter Lumbar catheter length : once insert until 3rd marker　（=27cm） remove TUOHY needle carefully remove 5-6cm from 3rd marker 10cm 11cm TUOHY NEEDLE 1st marker : 9cm 3rd marker : 27cm 2nd marker : 18cm 5-6cm * * * * * * Before guideline of iNPH, mimicing neurodegenerative disease were include in iNPH. The risk of immediate intraparenchymal hematoma from ventricular catheter insertion or delayed subdural hematoma from overdrainage can be significant, and may be worse in NPH patients due to decreased brain elasticity and subdural space expansion when the lateral ventricles are collapsed by overdrainage. Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery 2002;51:1392–400 [discussion 400–2]. The Dutch NPH Study reported subdural hematoma and hygroma rates as high as 71% in patients with low-pressure valves. * adverse event　４％　 in SINPHONI * * * * * * In newborn infants the opening pressure at implantation should be set low and increased later, usually within the first 2 months. The magnitude of single adjustments was generally not larger than 30 or 40 mm H2O because a larger adjustment can be risky. Retrospectively, we estimate that, in at least one fourth of patients, valve exchange would have been necessary if nonprogrammable valves had routinely been used. * * * * This is an in vitro experiment, in which valves were submitted to a 3T MRI for 15 min, 1 hour, 6 hours and 12 hours. * 1 – An experiment was done, to study the potential influence of magnetic fields induced by mobile phones