Therapeutische Probleme beim Hydrocephalus mit Krankhaften Liquorbeimengungen

Abstract

In hydrocephalus patients who have been treated by a ventriculo-auriculostomy system blockage is a frequent complication for which often pathological cerebrospinal fluid (CSF) additives are responsible. Presented to this topic are the case histories of four hydrocephalic children whose CSF in three of the cases contained increased protein, cells or both; the fourth case concerned a hydrocephalus after the operation of an extended lumbal meningo-myelocele.

The primary ventriculoauriculostomy, which was undertaken according to the SPITZ-HOLTER method, brought an improvement in none of the cases. Clinical tests as well as operative reviews forced one to assume a damaged system in the valve area; the ventricle catheter as well as the cardiac catheter had proved themselves perfectly permeable and correctly situated. In two cases the removed valves were blocked; through both the other valves one was able to inject saline solution; with this simple test no damage was determined. On all four children the cardiac catheter was left in place, connected with HAKIM's middle pressure valves and joined to HAKIM's ventricle catheters which were frontally applied.

Progress after the revisional operations was characterized in all the cases by a good retreat of the hydrocephalus and the thriving of the children. The clinical and operative reports as well as the course of the illnesses of the four children discussed speak for the assumption that apparently HAKIM's valves expedites pathological CSF additives better than HOLTER valves. This could be connected to the various construction principles of the two valves: it is conceivable that the narrow slits of the HOLTER valves agglutinate more easily by a pathological CSF than the metal funnels of the HAKIM valves whose opening can expand according to an increasing CSF pressure as well as CSF additives (I 11. 2).

Zusammenfassung

Es wird über 4 Kinder berichtet, die wegen eines schweren kommunizierenden Hydrocephalus mit einer Ventrikulo-Aurikulostomie nach SPITZ-HOLTER behandelt wurden. Bei dreien der Kinder war der Liquor aus verschiedenen Gründen pathologisch verändert (Zellen und Eiweiß). In allen 4 Fällen ging der Hydrocephalus durch die Behandlung nicht zurück. Jedesmal mußte die Ursache der Insuffizienz des Systems im Ventil gesucht werden, von denen sich 2 tatsächlich als verstopft (durch Fibrin und Zellen) erwiesen, während die beiden anderen bei einfacher funktioneller Prüfung intakt schienen.

Nach Implantation von HAKIM-Ventilen bildeten sich die Krankheitssymptome gut zurück. Die klinischen Verläufe werden anhand der unterschiedlichen Konstruktionsmerkmale der Ventile diskutiert, wobei entsprechendes Schrifttum in die Betrachtungen einbezogen wird.

Keyword

hydrocephalus - ventriculoatrial shunt - system blockage - pathological cerebrospinal fluid additives