髄液短絡装置の流量測定法

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A method for quantitative measurement of CSF flow through the ventriculo-peritoneal shunt is described.A Pudenz type shunt reservoir was punctured with a 26 gauge needle and a 0.03 ml of ^lt:99m>TcO_4-was injected, then the radioactivity over the reservoir was counted continuously for 10 minutes.An in vitro experiment using a calibrated infusion pump showed a single exponential washout curve when the flow rate was between 0.667 ml/min and 0.0278 ml/min.The flow rate through the shunt (q) could then be estimated using the formula:q=V・log 2/T_<1/2> where V is the volume of the reservoir and T_<1/2> is a clearance half-time.In this experiment the volume of the reservior was assumed to be 0.375 ml and the maximum error for estimation of flow rate was 25%.The measurement was perfomed 74 timrs for 55 patients.In 18 measurement perfomed on patients diagnosed to have malfunction of the shunt system, the washout curve showed a flat pattern except for two occasions where the flow rates were 0.011 ml/min and 0.016 ml/min.In 39 cases in which the shunt system was considered to be functioning adequately, the mean flow rate through the shunt was 0.14±0.115ml/min.The flow was significantly lower when the opening pressure of the slit value at the peritoneal tube was higher or the anti-siphon system was installed.In 8 cases with obstructive hydrocephalus due to posterior fossa tumor, the mean flow rate was 0.186±0.108ml, which was higher than the value in 10 cases after subarachnoid hemorrhage of 0.115±0.058ml/min.In cases after subarachnoid hemorrhage there was a tendency that the flow rate through the shunt gradually decreased as time elapsed.The flow rate was significantly influenced by positional change during the study unless the anti-siphon system was installed.Two representative cases with simultaneous measurement of intracranial pressure are presented.In conclucuin, this technique measurement of flow rate through the shunt not only provides access as to the adequacy of the shunt for the patient, but also may contribute to the study of dynamic mechanism of the third circulation.
日本脳神経外科学会の論文
1979-09-15

髄液短絡装置の流量測定法

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