Zusammenfassung
Zielsetzung der vorliegenden Arbeit war es, die katamnestischen Ergebnisse der operativen Therapie
des idiopathischen Normaldruckhydrozephalus zu untersuchen. Patienten und Methode: In einer prospektiven Verlaufsbeobachtung von durchschnittlich 3 Jahren (14 - 82
Monate) untersuchte man 51 Patienten, die wegen eines idiopathischen Normaldruckhydrozephalus
operativ durch die Anlage eines ventrikuloperitonealen Shunts mit einem Gravitationsventil
therapiert wurden. Ergebnisse: Der Anteil sehr guter, guter und befriedigender Ergebnisse betrug direkt postoperativ
80 %. Durchschnittlich 34 Monate postoperativ konnte noch bei 67 % der Patienten ein
sehr guter, guter oder befriedigender Krankheitsverlauf verifiziert werden. Beide
Ergebnisse liegen im Rahmen dessen, was in der internationalen Literatur berichtet
wird. Auch das Ergebnis der neuroradiologischen Untersuchung, ein minimaler Rückgang
der mit dem Evans-Index registrierten Ventrikelvolumina während des Behandlungsverlaufs,
deckt sich mit den Angaben aus der neueren Literatur und dem aktuellen pathophysiologischen
Verständnis der Hydrozephalustherapie. Schlussfolgerungen: Der Einsatz von Gravitationsventilen in der Therapie des idiopathischen Normaldruckhydrozephalus
ist die folgerichtige Umsetzung des heutigen Wissens über die pathomechanischen Zusammenhänge
dieses Krankheitsbildes. Dem bereits in früheren Studien nachgewiesenen Bedürfnis
einer Liquordrainage mit möglichst niedrigem Öffnungsdruck konnte sich bei gleichzeitiger
Protektion vor Überdrainagen erfolgreich angenähert werden. Aus Sicht der Autoren
wäre der Einsatz programmierbarer Ventile in Verbindung mit einer Gravitationskomponente
als nächste Evolutionsstufe anzusehen, da auf diesem Wege Revisionsoperationen aufgrund
von primär falsch ausgewählten Ventilöffnungsdrücken unnötig würden.
Abstract
Objective: To investigate the clinical outcome of patients with normal pressure hydrocephalus
three years after the implantation of a ventricular-peritoneal shunt. Materials and methods: 51 patients with idiopathic normal pressure hydrocephalus underwent a cerebrospinal
shunt insertion with a gravitational valve. In a prospective follow-up study we evaluated
the clinical outcome at an average of three years (14 to 82 months) after surgery.
Results: Directly postoperative excellent, good or satisfactory results occurred in 80 % of
the patients. At an average of 34 months after surgery 67 % showed an excellent, good
or satisfactory course of disease. We observed a minimal decrease of the ventricle
width registered with the Evans index during the therapy. This, as the outcome, corresponds
to the data in the international literature. Conclusion: The use of gravitational valves in the therapy of the normal pressure hydrocephalus
is the consistent realization of today's knowledge about the pathophysiology of the
disease. Recent studies showed the need of a cerebrospinal fluid drainage with a low
valve opening pressure and at the same time a protection from overdrainage. Our scheme
of therapy is conformable to these findings. From the author's point of view the use
of programmable valves combined with gravitational components is the next step of
evolution because re-operations due to an unfitting valve opening pressure would be
unnecessary.
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Priv.-Doz. Dr. med. Ullrich Meier
Klinik für Neurochirurgie · Unfallkrankenhaus Berlin
Warener Straße 7
12683 Berlin
Email: ullrich.meier@ukb.de
