可调压脑积水分流管PPT课件.ppt

Aesculap. All it takes to operate.Aesculap NeurosurgeryMIETHKE proGAVAdjustable Hydrocephalus Shunt可调压脑积水分流管1 Aesculap. All it takes to operate.Aesculap NeurosurgeryMIETHKE proGAVAdjustable Unit可调压部分Gravitational Unit重力抗虹吸部分2 Aesculap. All it takes to operate.Aesculap Neurosurgery过度分流过度分流外界干扰下的意外调节外界干扰下的意外调节需要在需要在X线透视状态下验证线透视状态下验证MRI检查的安全性检查的安全性操作操作阀门安装位置的局限性阀门安装位置的局限性调压的范围调压的范围International Shunt-expert Alfred Aschoff, MD,PhD, Neurosurgeon at 10th European Congress of Neurosurgery, Berlin, May 9t, 2019.可调压脑积水分流系统存在的一些问题可调压脑积水分流系统存在的一些问题3 Aesculap. All it takes to operate.Aesculap Neurosurgery材料材料竞争对手竞争对手: :硅胶工艺硅胶工艺4 Aesculap. All it takes to operate.Aesculap Neurosurgery材料材料我们的技术我们的技术: :Titanium5 Aesculap. All it takes to operate.Aesculap Neurosurgery 高质量的钛以及合成硅树植高度的生物相容性长期的稳定性,不会老化不受皮层压力的影响良好的核磁兼容性材料材料6 Aesculap. All it takes to operate.Aesculap Neurosurgery当患者站立的时候当患者站立的时候, ,造造成过多的成过多的CSF被引流被引流! !对患者造成的后果对患者造成的后果: :过度分流过度分流7 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV解决的技术方案解决的技术方案: :利用患者体位的变化利用患者体位的变化来平衡虹吸压力来平衡虹吸压力重力抗虹吸阀门重力抗虹吸阀门! !过度分流过度分流8 Aesculap. All it takes to operate.Aesculap Neurosurgery外界干扰下阀门被意外调节外界干扰下阀门被意外调节Literature:Schneider, Knauf, Nitsch Magdeburg, Germany (2019)Electromagnetic field hazards involving adjustable shunt valves in hydrocephalus“9 Aesculap. All it takes to operate.Aesculap Neurosurgery外界干扰下阀门被意外调节外界干扰下阀门被意外调节Literature:Anderson, Walker, Viner, Kestle Salt Lake City, USA (2019)Adjustment and malfunction of a programmable valve after exposure to toy magnets“10 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV解决的技术方案解决的技术方案: :皮肤外可以使机械制动闸解锁皮肤外可以使机械制动闸解锁 SNSN外界干扰下阀门被意外调节外界干扰下阀门被意外调节11 Aesculap. All it takes to operate.Aesculap NeurosurgeryNSSNSNSN外界干扰下阀门被意外调节外界干扰下阀门被意外调节12 Aesculap. All it takes to operate.Aesculap NeurosurgerySNSNNSSN外界干扰下阀门被意外调节外界干扰下阀门被意外调节13 Aesculap. All it takes to operate.Aesculap Neurosurgery特别对于小儿病人特别对于小儿病人! !对病人至关重要对病人至关重要( (反复反复X-ray检查造成辐射损害检查造成辐射损害) ): :X-ray 验证验证14 Aesculap. All it takes to operate.Aesculap Neurosurgery时间和经济损失时间和经济损失对医生也是至关重要对医生也是至关重要: :X-ray 验证验证15 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV技术的解决方案技术的解决方案: :只需要一支笔只需要一支笔! !X-ray 验证验证16 Aesculap. All it takes to operate.Aesculap Neurosurgery阀门开放压力是如何被测量的阀门开放压力是如何被测量的? ?1. 阀门的定位17 Aesculap. All it takes to operate.Aesculap Neurosurgery刻度显示部位对准脑室端管方向2. 安放检测工具WrongCorrect阀门开放压力是如何被测量的阀门开放压力是如何被测量的? ?18 Aesculap. All it takes to operate.Aesculap NeurosurgeryVentricle Cathether阀门开放压力是如何被测量的阀门开放压力是如何被测量的? ?19 Aesculap. All it takes to operate.Aesculap Neurosurgery阀门开放压力是如何被测量的阀门开放压力是如何被测量的? ?20 Aesculap. All it takes to operate.Aesculap Neurosurgery压力识别标尺压力识别标尺0 cmH2O20 cmH2O11 cmH2OMarker21 Aesculap. All it takes to operate.Aesculap Neurosurgery标记标记22 Aesculap. All it takes to operate.Aesculap NeurosurgeryScout view23 Aesculap. All it takes to operate.Aesculap Neurosurgery操作困难操作困难! !Consequence for the adjustment:操作操作24 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV技术的解决方案技术的解决方案只需要用第二支笔来调节只需要用第二支笔来调节! !操作操作25 Aesculap. All it takes to operate.Aesculap Neurosurgery1. 调整压力计的数值如何调整开放压力如何调整开放压力? ?26 Aesculap. All it takes to operate.Aesculap Neurosurgery2. 阀门定位如何调整开放压力如何调整开放压力? ?27 Aesculap. All it takes to operate.Aesculap Neurosurgery3.安放检测工具如何调整开放压力如何调整开放压力? ?28 Aesculap. All it takes to operate.Aesculap Neurosurgery3.安放检测工具如何调整开放压力如何调整开放压力? ?29 Aesculap. All it takes to operate.Aesculap Neurosurgery3.安放检测工具如何调整开放压力如何调整开放压力? ?30 Aesculap. All it takes to operate.Aesculap NeurosurgeryIncorrectCorrect3.安放检测工具如何调整开放压力如何调整开放压力? ?31 Aesculap. All it takes to operate.Aesculap NeurosurgeryVentricle Catheter如何调整开放压力如何调整开放压力? ?32 Aesculap. All it takes to operate.Aesculap Neurosurgery如何发现埋在皮如何发现埋在皮下的阀门下的阀门? ?对调节器非常重要对调节器非常重要: :阀门的定位阀门的定位33 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV技术的解决方案技术的解决方案: :用一个磁性的罗盘即可做到无创的检查用一个磁性的罗盘即可做到无创的检查! !阀门的定位阀门的定位34 Aesculap. All it takes to operate.Aesculap Neurosurgery调节的跨度太大调节的跨度太大, ,无法细分无法细分! !临床治疗过程必须面对的问题临床治疗过程必须面对的问题: :压力调整的范围压力调整的范围35 Aesculap. All it takes to operate.Aesculap NeurosurgeryproGAV技术的解决方案技术的解决方案: :在在0-2000-200mmH2O的的压力范围之内可压力范围之内可做到任意覆盖做到任意覆盖压力调整的范围压力调整的范围36 Aesculap. All it takes to operate.Aesculap NeurosurgeryCODMANProgrammable Valve (Hakim-Medos)可调压阀门储液囊 返流阀37 Aesculap. All it takes to operate.Aesculap NeurosurgeryProgrammable Valve (Hakim-Medos)转子能够被磁场通过皮肤进行转动,因此造成弹簧张力发生变化,从而导致阀门的开放压力发生变化弹簧转子近端阀体38 Aesculap. All it takes to operate.Aesculap NeurosurgeryArgumentation Hakim-Medos(讨论讨论) )可调压力阀门,而不是可编程阀门当体位发生变化之后(站立),阀门能够自动 编程或调节吗?平躺时压力偏高,站立时压力偏低如果患者是在平躺时设定压力,那么当其站立时就会增加过度引流发生率 经常发生病人要求调整压力的状况 是件非常麻烦的事39 Aesculap. All it takes to operate.Aesculap NeurosurgeryArgumentation Hakim-Medos(讨论讨论) )压力水平的设定后的确认只能通过X摄片(is annoying for children) 甚至于最高的压力设定值也不能补偿流体静力学压力设定压力被外界磁场所意外调节是不受控制的非常大的阀门昂贵工作过程却类似于廉价的传统微分压力阀 (DPV)40 Aesculap. All it takes to operate.Aesculap NeurosurgeryCODMANSiphonGuard限制虹吸的装置 (连接于可调压力阀门)只有一种单纯的设计,容易引起过度引流或者分流不足该机械装置非常容易发生梗阻41 Aesculap. All it takes to 。