Lumbal shunting

In contrast to shunt operation the indication for an endoscopic ventriculostomy in patients diagnosed for normal pressure hydrocephalus is not scientifically established. From September 1997 to October 2001 we operated on 79 patients diagnosed for normal pressure hydrocephalus. Diagnosis was established by means of the intrathecal lumbal or ventricular infusion test, the cerebrospinal fluid tap test and MRI-CSF flow studies pre- and post-operatively. In 60 patients (76 %) we implanted a ventriculo-peritoneal shunt (Miethke Dual-Switch valve), and in 15 patients (19 %) we performed the endoscopic assisted third ventriculostomy...

The aim of the study is to inform professionals about a serious complication--the liquor malabsorption--developing in relation to the routinely performed roentgen-contrastive examination (PMG). It also demonstrates advantages of the lumbal infusion test (LIT) as a part of the algorithm of the shunt operation in patients with supposed pathology of liquor malabsorption.

PURPOSE: To demonstrate the usefulness of B-scan ultrasonography and color Doppler ultrasonography (CCDS) in the diagnosis of lumbal and splenorenal collateral veins in patients with liver cirrhosis. METHOD: 46 patients with histologically proven liver cirrhosis were examined by means of B-scan ultrasonography. CCDS was used to demonstrate the vascular character of mass-like lesions or tortuous tubular structures. Esophageal varices were demonstrated in 23 (50%) and ascites in 6 patients (13%)...

Shunt dependent patients with clinical signs of shunt malfunction and slit ventricles on computerized tomography could suffer either from low pressure or from a slit-ventricle-syndrome with increased pressure. In such cases we recommend a lumbal punction with pressure monitoring to make the diagnosis certain. In case of increased pressure we firstly inject 0.9% NaCl into the proximal part of the ventricular catheter to remove it's obturation. Sometimes shunt revision can so be avoided in the slit-ventricle-syndrome...

In 1919 Wegeforth, Ayer and Essick described the direct puncture of cisterna cerebello-medullaris. Without knowledge and independent of this Karl Eskuchen recommended in 1923 to tap the cistern after touching the squama occipitalis before. His proceeding found general resonance. It is less dangerous and practicable without much experience. Originally there were numerous diagnostical, therapeutical and scientific indications for the suboccipital puncture. Most of them are out of date. Still, it is the only practicable alternative when the lumbal puncture was with no purpose...

Our experiences in the course of illness of very low birth weight infants suffered from posthemorrhagic hydrocephalus are described. Clinical proceedings for performing of the hydrocephalus are explained, advantages and disadvantages of treatment by serial lumbal punctures, influences of drugs on the dilatation of the ventricles and the insertion of ventriculo-peritoneal shunts are discussed. The outcome was unfavourable in hydrocephalus following Grad III ore IV hemorrhage. Therefore the prevention of severe hydrocephalus must be the common sense of obstetricians and neonatologists...