The method of selection of patients with epilepsy to lumboperitoneal

 

(57) Abstract:

The invention relates to medicine, namely neurosurgery. Spend infusion-load test and the resistance to resorption of the cerebrospinal fluid more than 10.5 mm RT.art./ml/min and the values of the volume - pressure index craniospinal system more than 12 ml take the decision to hold lumboperitoneal bypass. The method reduces the invasiveness and reduce postoperative complications.

The invention relates to medicine, namely, neurosurgery, and can be used for the selection of patients for surgical treatment of drug-resistant epilepsy.

In the surgical treatment of epilepsy used lumboperitoneal (Romodanov A. P., Lomonosov O. D., Tosevski C. F., Ilyuk Y. I. Liquore-hemodynamic disorders in the pathogenesis of epilepsy./Surgical treatment of epilepsy, Tbilisi, 1985, S. 87-88), creating the outflow of CSF from the end tank of the spinal cord into the abdominal cavity. However, the low efficiency of the method is caused by the absence of a well developed system for the selection of patients.

Closest to the claimed method is a method of selecting patients for epilepsy lumboperitoneal the Changes in elastic properties of the liquor system in patients with post-traumatic epilepsy./Surgical treatment of epilepsy, Tbilisi, 1985, S. 100-101), resulting in cessation of seizures and normalization of the picture electroencephalography (EEG), adopted for the prototype. This produces a lumbar puncture, and through a lumbar needle or, more commonly, through the implanted catheter in the end tank of the spinal cord spend extended external CSF drainage (from several days to several weeks). This evaluate clinical data (frequency, severity and nature of epileptic seizures), and EEG data. Positive dynamics of clinical and electroencephalographic pattern (termination of epileptic seizure and improved picture EEG) after long-term outdoor excretion of liquor make a decision on holding lumboperitoneal bypass.

The disadvantages of this method are:

- low efficiency: to adequately assess the dynamics of clinical and electroencephalographic manifestations of epilepsy in the short term (for the manifestation of changes in the EEG pattern) external CSF drainage impossible. There is a necessity of increasing the duration of external CSF drainage, which is technically difficult and could increase the risk of infectious complications and gipertenziah of oslojnenny the tion was impossible. This was the reason, in 1/4-1/3 observations of liquorshunting surgery to treat epilepsy are ineffective.

- traumatic catheterization, lumbar Saka with subsequent long-term external drainage of cerebrospinal fluid, which, in turn, is fraught with the development of infectious complications and hypotensive syndrome. Our observations and according to other authors, such complications in 5-25% of cases.

The invention is directed to a method for the selection of patients with epilepsy to lumboperitoneal, allowing to increase the efficiency, reduce the invasiveness and reduce the risk of postoperative complications.

This technical result in the implementation of the invention is achieved by that conduct infusion-load test and the resistance to resorption of the cerebrospinal fluid more than 10.5 mm RT.art./ml/min and the values of the volume - pressure index craniospinal system more than 12 ml take the decision to hold lumboperitoneal bypass.

The method is as follows. A patient with drug-resistant epilepsy in the presence of extension levorotary cavities produce a lumbar puncture, the output luring and get the original curve. Spend infusion-load test (IAT) (Anthony Marmarou, Ph.D., Kenneth Shulman, M. D., and James LaMorgese, M. D., Compartmental analysis of complianse and outflou resistance of the cerebrospinal fluid system, J. Ncurosurg., Volume 43, November, 1975). Measure the resistance resorption of CSF volume - pressure index craniospinal system. At high (more than normal) resistance to resorption of CSF (>10.5 mm RT.art./ml/min) and increase the volume - pressure index craniospinal system (12 ml) accept the decision to hold the needle lumboperitoneal.

The inventive method for the selection of patients for epilepsy lumbopelvic-neotomae developed and clinically tested in the Polenov research neurosurgical Institute them. Professor A. L. Polenov in the treatment of 15 patients with drug-resistant epilepsy, which after infusion-load test, it was decided to hold lumboperitoneal. Comprehensive post-operative examination of the patients revealed the termination of epileptic seizure at 75% and a reduction in clinical elektroentsefalograficheskih manifestations of epilepsy in 25% of patients. Compared with the control group (28 patients), which infusion-load test before lumboperitoneal was not carried out, showed that in this way significantly (P<0,01) decreased the frequency of infectious, gipertenziah of oslojnenny is er - an extract from a case history No. 1590-2000

Patient W., 7 years. The diagnosis of Drug-resistant epilepsy with frequent generalized seizures. Soamsawali internal tetratetracontane hydrocephalus. Leading the clinical picture was epileptic syndrome presents frequent (up to 30-40 times a day) generalized seizures. Pathology of the ocular fundus is not revealed. On brain MRI moderately expressed tetratetracontane soamsawali hydrocephalus. EEG pattern indicated high convulsive readiness brain expressed diffuse changes in the bioelectrical activity of the brain, predominant in the right hemisphere and more in the occipital region, against the backdrop of ongoing anticonvulsant therapy apicomplexan not registered. According to the claimed method 08.08.2000 patients received infusion-load test, the measured resistance resorption of CSF-12 (> 10.5 mm RT.art./ml/min), the volume - pressure index craniospinal system 14 (> 12.0 ml). On the basis of the obtained data made the decision to hold the needle lumboperitoneal. In the postoperative period epileptic seizures were observed, the child in addition has become more manageable in the behavior, the less varstva before prototype:

- Increase in efficiency is achieved by the fact that quantitatively determine the parameters of liquorrhea, thus achieves invariance decision. This results in improved treatment outcomes by 10.2%.

- Reduce the morbidity caused by the lack of necessity for external drainage for a long period of time, allowing significant to reduce the frequency of infectious complications associated with external drainage.

The method of selection of patients with epilepsy to lumboperitoneal, characterized in that conduct infusion-load test and the resistance to resorption of the cerebrospinal fluid more than 10.5 mm RT. senior/ml/min and the values of the volume-pressure index craniospinal system more than 12 ml take the decision to hold lumboperitoneal bypass.

 

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