Yusuke Ishiwata

Thermosensitive Determination of Patency in Lumboperitoneal Shunts: Technical note

Surface cooling and thermistor recording over shunt tubing was used in 23 studies of cerebrospinal fluid shunt patency in 19 patients with lumboperitoneal shunts and normal-pressure hydrocephalus. Shunt patency was shown by downward reflection of the recording trace similar to that obtained for ventriculoperitoneal shunts. Obstruction was demonstrated by a flat-line recording or an upward deflection.

Analysis of CSF Flow Through LP Shunt During Change of Posture

Two methods for percutaneous study of lumboperitoneal (LP) shunt patency are described. The first is an LP shuntography in which patency of the shunt can be assessed by the intraperitoneal spread of contrast medium injected intrathecally via the lumbar route. This method was performed in 27 hydrocephalic patients. The other is a thermosensitive determination technique, in which patients. The other is a thermosensitive determination technique, in which patency of the shunt can be assessed by definite temperature changes. In a patient with an LP shunt, flow of CSF, and hence patency of the shunt, are indicated by a downward deflection of the recording trace. Twenty-three trials of the thermosensitive determination of CSF shunt patency in LP shunts of 19 hydrocephalic cases were performed. We got five different types of recording traces by the thermosensitive method. A flat-line recording (2 recordings) and an upward deflection (2 recordings) showed complete occlusion. Operative findings and LP shuntgraphy showed that four cases with a nearly flat line recording had a partial occlusion of the shunt. Patency of the shunt was comfirmed by LP shuntgraphy in all cases (12 recordings) with a gradual downward deflection. A steep downward deflection showed an acute excessive CSF drainage. An experimental study was carried out to perform a quantitative analysis of CSF flow in an LP shunt. Derived data suggested that the flow velocity was 10 ml/hr in a case with a nearly flat-line recordings, 30 ml/hr in a case with a gradual downward deflection and 60 ml/hr in a case with a steep downward deflection. An acute excessive CSF drainage which was suggested by a steep downward deflection and findings of LP shuntgraphy was shown to be dangerous.

Von Hippel-Lindau Disease

Two cases of von Hippel-Lindau disease are presented. Case 1 was a 52-year-old male with four lesions: a cerebellar hemangioblastoma, an intraventricular metastatic tumor, a renal cell carcinoma, and a liver cyst. The patient died of intraventricular hemorrhage due to a metastatic brain tumor of the renal cell carcinoma. Brain metastasis of the renal cell carcinoma of von HippelLindau disease is extremely rare. Case 2 was a 24-year-old male with five lesions: a cerebellar hemangioblastoma, a spinal hemangioblastoma, a pancreatic cyst, a pheochromocytoma, and multiple renal cysts. Spinal angiography was useful in the diagnosis of the spinal tumor. The elder brother of the patient has an asymptomatic renal cyst. Twenty-five distinct lesions have been reported in von Hippel-Lindau disease. Computed tomographic screening seems to provide typical image of the central nervous and abdominal tumors.