Item type |
学術雑誌論文 / Journal Article(1) |
公開日 |
2022-02-01 |
タイトル |
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タイトル |
Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures. |
言語 |
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言語 |
eng |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
idiopathic normal pressure hydrocephalus (iNPH) |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
ventriculoperitoneal shunt (VP shunt) |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
ventricles |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
cerebrospinal fluid (CSF) |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
pressure adjustment and management |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
CSF tap test |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
DESH |
キーワード |
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言語 |
en |
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主題Scheme |
Other |
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主題 |
preoperative simulation |
資源タイプ |
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資源タイプ識別子 |
http://purl.org/coar/resource_type/c_6501 |
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資源タイプ |
journal article |
著者 |
YAMADA, Shigeki
ISHIKAWA, Masatsune
NAKAJIMA, Madoka
NOZAKI, Kazuhiko
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著者別名 |
山田, 茂樹
野﨑, 和彦
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抄録 |
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内容記述タイプ |
Abstract |
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内容記述 |
Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later. |
書誌情報 |
en : Frontiers in Neurology
発行日 2022-01-06
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出版者 |
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出版者 |
Frontiers Media S.A. |
ISSN |
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収録物識別子タイプ |
ISSN |
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収録物識別子 |
1664-2295 |
PMID |
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関連タイプ |
isIdenticalTo |
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識別子タイプ |
PMID |
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関連識別子 |
35069426 |
PMCID |
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識別子タイプ |
URI |
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関連識別子 |
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc8770742/ |
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関連名称 |
PMC8770742 |
DOI |
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関連タイプ |
isIdenticalTo |
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識別子タイプ |
DOI |
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関連識別子 |
https://doi.org/10.3389/fneur.2021.798488 |
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関連名称 |
10.3389/fneur.2021.798488 |
権利 |
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権利情報 |
© 2022 Yamada, Ishikawa, Nakajima and Nozaki. |
フォーマット |
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内容記述タイプ |
Other |
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内容記述 |
pdf |
著者版フラグ |
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出版タイプ |
VoR |
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出版タイプResource |
http://purl.org/coar/version/c_970fb48d4fbd8a85 |
資源タイプ |
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内容記述タイプ |
Other |
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内容記述 |
Journal Article |