脳室腹腔吻合機能不全例に対するshunt function testの撰択

Shunt Function Tests for the Management of Malfunctioning Ventriculo-Peritoneal Shunts

Ⅰ．はじめに

　水頭症の治療には現在，脳室腹腔吻合術（V-P shunt）が広く行われている方法であるが，設置されたshuntが正常に働いているかどうかを判定し，follow upしてゆくことが，その治療上大切なことである．

　Shuntの機能状態は従来，臨床症状ならびにflushing deviceの触診所見によって判定されてきた．しかしながら，flushing deviceの所見が正常でありながら，臨床的にshunt機能不全症状をみる例や，逆にflushing deviceの所見は異常であるのに，臨床的に問題のないものがあり，flushing deviceの触診所見だけでは，shuntの機能を判定するうえで困難を感ずることが少なくない^6）．

Three kinds of shunt function tests, a quantitative measurement of CSF flow through the shunt, measurement of ventricular fluid pressure and opening pressure of the abdominal slit valve and positive contrast shuntgraphy were described. These tests were performed in 28 occasions with suspected malfunctions of V-P shunt.

In 15 occasions in which malfunctions were verified at the time of revision, the flow study and the pressure study showed abnormal results in all cases, while the shuntgraphy was normal in 2 occasions where inadequacy of the opening pressure of the slit valve causing chronic symptoms of shunt malfunctions.