| Purpose:Retrospective analysis the effectivity and safety of the two types of operative methods (Ventriculoperitoneal shunt and Lumboperitoneal shunt)with the use of programmable valve, and the initial choice of the pressure of bypass valve in streaming.Materials and Methods:A retrospective analysis 63 patients with communicating hydrocephalus that were treated at the Neurosurgery Department of Dalian Medical University from March 2013 to December 2014.The main clinical manifestations include headache, dysgnosia, gait disturbance, urinary incontinence, memory loss and coma. All patients were diagnosed with hydrocephalus by imaging examination, and eliminating tumor, congenital malformation, midbrain aqueductal stenosis caused by obstructive hydrocephalus(Post-traumatic hydrocephalus is 8,21 cerebral hemorrhage postoperative hydrocephalus,4 patients suffer from Intracranial placeholder postoperative hydrocephalus, Other idiopathic hydrocephalus are 30.). According to the family’s willing the lateral Ventriculoperitoneal shunt (VPS) group conclude 38 cases, lumboperitoneal shunt (LPS) group is 25,all selects the French Sophie non-invasive extracorporeal shunt voltage regulation system. Postoperative symptoms and radiographic was observed.adjust pressure based on the circumstance, till no sign of excessive divergence of low intracranial pressure. Analysis the curative effect of two groups, comparing the significant difference of two groups of patients with postoperative complications. Counting and measuring data were respectively used X2, P< 0.05 was considered the estatistically differenc significant.Results:Patients were followed up 3-24 months. Imaging review of 60 cases, ventricular expansion is reduced or disappeared, clinical symptoms ease or disappear. Imaging review shows:Ventricular expansion is reduced or disappeared in 2 cases, but no clinical symptoms improvement. The clinical effective case in LPS group was 20(80%), complications occurred in 4 cases(16%); the effective case in VPS group was 26(68.4%),. complicated 13(34.2%). Compared the effectiveness of LPS and VPS in treatment of traffic hydrocephalus, because the complications was less in LPS group during early postoperative, efficient was significantly higher than VPS group, Eefficient are slightly higher than VPS group during the middle and latter, but there was no statistically significant difference. Compare complications of the two groups, VPS obviously higher than that of LPS, but there is no statistical significance difference. VPS group six weeks complications was 21%, while LPS group appears only in 1 case, so the difference was statistically significant. LPS group long-term complications was 12%, VPS group long-term complications was 11%, compared two groups of the same period, the difference is not significant.63 cases of patients with postoperative regulating 63 times, average of 1.3 times, regulating 29 cases (46%), up to 5 times, the final pressure 90-110mmh2o 35 patients (55%), the final pressure were 20% lower than intraoperative lumbar puncture,48 cases (76%), All patients did not appear complications due to excessive diversion or inadequate shunt.Conclusions:The curative effect of using LPS and VPS in treatment of communicating hydrocephalus were both good. Compared with the VPS, LPS has a lower complication rate during early stage, could avoid cerebral hemorrhage, brain injury and secondary epilepsy caused by brain puncture. Puncturing in the proximal and distal, operation time was very short to achieve the goal for minimally invasive.There were lots of advantages, such as in significant effect, noninvasive regulation of pressure, surgical trauma little, no obvious low intracranial pressure symptoms after operation, short-term effect was significant. After repeated noninvasive adjustment with branch pipe pressure according to the imaging examination and symptoms in patients, we could avoid complications with excessive or inadequate shunt. |
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