日高 充 東海大学, 医学部, 助手 (90256123)
MATSUMAE Mitsunori Tokai University, School of Medicine, Assistant Professor, 医学部, 講師 (20209604)
竹井 太 東海大学, 医学部, 講師 (00216839)
TSUGANE Ryuichi Tokai University, School of Medicine, Professor, 医学部, 教授 (70022902)
SHINODA Masaki Tokai University, School of Medicine, Assistant Professor, 医学部, 講師 (70196393)
|Budget Amount *help
¥2,000,000 (Direct Cost : ¥2,000,000)
Fiscal Year 1998 : ¥300,000 (Direct Cost : ¥300,000)
Fiscal Year 1997 : ¥200,000 (Direct Cost : ¥200,000)
Fiscal Year 1996 : ¥1,500,000 (Direct Cost : ¥1,500,000)
Although the neuroendoscopic surgery, especially for treatment of non communicating hydrocephalus, has been widely applied, the definitive indication for and preoperative evaluation for postoperative efficacy remain the future subjects in hydrocephalus research. Neuroendoscopic surgery was used to treat patients with various forms of hydrocephalus with specific pathophysiology, including long-standing overt ventriculomegaly in adult (LOVA), isolated unilateral hydrocephalus (IUH), isolated fourth ventricle (11W), disproportionately large fourth ventricle (DLFV), isolated rhombencephalic ventricle (IRV), isolated quarto-ventriculomegaly (IQV), dorsal sac in holoprosencephaly (DS), and loculated ventricle (LV). The characteristics of the cerebrospinal fluid (CSF) dynamics in the individual specific pathophysiologies were delineated by cardiac-gated cine-mode magnetic resonance imaging (MM) before and after the endoscopic procedure. The postoperative changes of ventriculomegaly were compl
icated, reflecting the difference in the brain parenchymal compliance and postoperatively corrected CSF flow dynamics in the major CSF pathway. LCP dynamics, usually in a relatively acute or subacute period in secondary hydrocephalus, the brain parenchymal compliance is well preserved. Small amount of CSF withdrawal by the shunt may normalize the high amplitude of pressure waves (HCA Stage-III). In contrast, a low- or extremely-low-pressure system may be necessary in the stage of relatively low ICP level. The compliance is lost and usually pulse pressure is small in range, with relatively low baseline pressure. (late HCA Stage-Ill and HCA Stage-IV). In these stages, a shunt system should delete the pressure waves ranging in a mildly abnormally high or even within a normal but relatively high ICP level.
The results obtained from this project in 1996-1998 included
1) The first trial and established concept of "Experimental Animal Neuroendoscopy", 2) Analyses of the local fine ICP dynamics/CSF flow dynamics, 3) Proposal of new concepts of hydrocphalus, i.e., LOVA, True NPH, hydrocephalic dementia (HD) in adult hydrocephalus, and 4) Established neuroendoscopic surgical technique and indication for ventriculostomy.
本研究課題の3年間の総括的成果には、1)神経内視鏡の基礎動物実験学的応用(experimental animal neuroendoscopy)、2)水頭症特殊病態における髄液循環動態(CSF hydrodynamics)及び頭蓋内圧の局所圧動態(local fine ICP dynamics)の解析、さらにこれらに基づいて 3)新たな水頭症病態の提唱(LOVA,True NPH,Hydrocephalic Dementia)と 4)神経内視鏡手術の適応とその手技の確立等があげられる. Less