《腰大池腹腔分流》PPT课件.ppt

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1、St.MariannaUniversitySchoolofMedicineDepartmentofNeurosurgeryKotaroOshioM.D.PhD.Thepreparationandpracticalsurgicaltechniqueoflumboperitonealshunts腰大池-腹腔分流术前准备及临床手术方法TopicsHistoricalbackgroundofLPshuntingLP分流的历史背景BenefitsandcomplicationsofLPshuntingExperienceinusingLPshuntingLP分流的优势及

2、并发症——使用经验IndicationofLPshuntingDiagnosisiNPHaccordancewiththeguidelinesLP分流的适应症——自发性正常颅压脑积水的诊断VideoseminarThedetailedprocedureofLPshunt手术视频——LP分流的具体步骤WhyLPshuntwasnotstandard?AndWhyLPshuntnow?为什么LP分流曾经不是标准而现在广泛使用？FirstintroductionofLPshuntwas1950’s.Fortreatmentofhydrocephalus.LP分流最

3、早于1950年推出，以治疗脑积水Simpletechnique但技术很简单MostneurosurgeonhesitatetodoLPshunt.Because“Toomuchcomplication”then.很多的神经外科大夫由于术后太多的并发症，而放弃LP分流Improvement改良Material&Equipment材料和设备“Diagnosis”诊断HistoryofLPshuntLPLP分流的历史1950’sfirstintroductionMaterial:polyethylene聚乙烯->Xinducearachnoiditisandscol

4、iosis引起蛛网膜炎和脊柱侧凸1975Selmanet.al.Material:Silicone硅树脂->OlessarachnoiditisandscoliosisComplication:LPshunt＞VPshuntposturaloverdrainage:SDFC&SDHEtc.Diagnosis&Treatmentdifficult!favorableindication:communicatinghydrocephalus给诊断和治疗带来困难Improvementofthematerial材料的改进Unfortunately,NOadjustab

5、levalve!NOCTscan,NOMRI!没有可调压阀门，没有CT，没有MRIMRICTAntisiphondeviceAdjustableValveAccuratediagnosis&lesscomplicationinshuntsurgery准确诊断、并发症少BeforemakingguidelineofiNPHHebbandCusimanoNeurosurgery:49,No.5,2001ShuntingINPHsystematicreview:Suggest:CriteriaforiNPHisnotunified(没有统一的标准iNPH)signi

6、ficantimprovement:only29%(range10-100%)Complicationsoccurredin38%(range,5–100%)Requiredadditionalsurgery22%(range,0–47%)permanentneurologicaldeficitanddeath:6%(range,0–35%)life-threateningintraparenchymalorsubduralhematomasrequiringsurgicalevacuation.⇒ThispaperisFoundationofguidelin

7、eDiagnosisEvolution诊断的发展Diagnosticradiologicalequipment:CT,MRIClarifyofthepathophysiology:iNPHguideline放射诊断设备：CT，MRI明确的病理生理：INPH方针Before2000iNPH“Treatabledementia”Shuntresponderonly29%在2000年之前，INPH“可治疗老年痴呆症”分流治疗者只有29％Diseasedementia(Alzheimertype)老年痴呆症Neurodegenerativedisease神经退行性疾病

8、Complication38%iNPH