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Rehabilitation Practice and Science

Translated Title

引流管功能異常在水腦症病患之治療經驗：病例報告

Abstract

We report a case of an adult patient with post-traumatic hydrocephalus who was treated using a ventriculoperitoneal (VP) shunt with a fixed pressure setting valve. Slit ventricle syndrome was found two months later and an antisiphon device (ASD) was added. A fixed pressure valve with ASD was found not to be optimal in terms of improving his neurological symptoms and a programmable valve system was therefore implanted with a pressure setting of 140 mmH2O in the beginning. The valve then was gradually programmed to reduce down to 70 mmH2O over two months. This case demonstrates that selection of a shunting device is difficult, and even after deliberate selection and use of an antisiphon device, slit ventricle syndrome could not be avoided. In addition, the patient in this case had increased episodes of seizure that were associated with acute intracranial hypertension; these were caused by obstruction. Good clinical monitoring of such patients is needed because of the intermittent nature of the high intracranial pressure symptoms. Notwithstanding this, minor complications involving shunt dysfunction may be neglected once the initial treatment has been completed in the neurosurgical ward and the patient has been transferred to a rehabilitation ward. It should be noted that this patient was very sensitive to over-drainage and siphoning was required in order to generate an effective transmantle pressure gradient. Thus, the highest valve setting available was used at the beginning of treatment and this was followed by a methodically lowering of the opening pressure based on the clinical response and computed tomography findings. Overall, the programmable valve shunt system would seem to be more effective when there is a need to deal with shunt dysfunction non-invasively.

Language

English

First Page

251

Last Page

259

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