The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H(2)O was implanted, and the pressure gradually increased. At a pressure of 120 mm H(2)O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H(2)O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H(2)O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.

译文

作者介绍了2例VP分流诱发的硬膜下血肿 (SDH) 患者,该患者接受了压力可编程瓣膜植入和内镜下第三脑室切开术 (TV) 治疗。第一位患者是一名11岁的女孩,患有分流诱导的SDH。使用较高压力阀修改分流阀会导致她的意识长期恶化。低压下的外部心室引流导致临床改善。植入设置在50毫米H(2)O的压力可编程阀,并且压力逐渐增加。在120毫米H(2)O的压力下,即使硬膜下集合的大小开始减小,症状也会复发。进行内窥镜TV,然后将瓣膜压力增加到200毫米H(2)O,而没有任何神经症状。第二名患者是一名7岁的男孩,患有分流诱导的SDH,即使在放置高压阀进行分流翻修后也出现了SDH复发,这导致了长时间的嗜睡。同时植入内窥镜电视的压力可编程阀。瓣膜压力逐渐增加至200毫米H(2)O可以进行而没有复发症状。最终,该分流系统被结扎以解决残留的位置头痛,并且该电视已获得3年以上的专利。在两名患者中,压力可编程阀都是有用的,因为在从有症状的硬膜下收集恢复期间,最佳的CSF引流压力发生了变化。并发电视似乎可以逐渐增加瓣膜压力,而没有任何神经系统症状。讨论了这种组合方法的优点。

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