Hydrocéphalie. Mesure du débit extériorisé du liquide cérébrospinal chez l'adulte hydrocéphale porteur d'une dérivation ventriculaire externe (DVE) : Relations pression et résistance en fonction du débit des systèmes de DVE

Abstract : Hydrocephalus is a hydrodynamic disorder of cerebrospinal fluid (CSF) responsible for an increasing volume of its dedicated compartment. We present the current knowledge regarding CSF and its dynamic (secretion, circulation and absorption), hydrocephalus and its treatment. In addition, we study intracranial pressure (ICP), a variable indissociable from the previous ones. In addition to this bibliographic research, this work is composed of a clinical research and a fundamental research. The aim of the clinical study is to monitor externalized CSF outflow (Q'extcsf) and ICP in hydrocephalic patients with external ventricular drainage. Twelve patients are included. The mean + SD Q'extcsf and ICP are respectively 7.5 + 3.4 ml/h and 12.4 + 2.7 mmHg. Two patterns of Q'extcsf are identified: a continuous profile and a discontinuous one. The short term variations of Q'extcsf and ICP are usually unrelated, presumably because of the pressure/volume relationships within the intracranial compartment. Q'extcsf is lower than the reference production rate (21 ml/h), raising the question of persistent CSF absorption and/or depressed secretion. The aim of the fundamental research is to compare the pressure/resistance relationships to flow of two external ventricular drainage sets. One of the two existing systems present, for lower outflow, a very important resistance, decreasing with flow increase, and stabilizing at 0.05 hPa/ml/h when flow reaches 20 ml/h. the other system shows an almost nil resistance whatever the flow.
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Olivier Klein. Hydrocéphalie. Mesure du débit extériorisé du liquide cérébrospinal chez l'adulte hydrocéphale porteur d'une dérivation ventriculaire externe (DVE) : Relations pression et résistance en fonction du débit des systèmes de DVE. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2009. Français. ⟨NNT : 2009NAN10137⟩. ⟨tel-01748302⟩

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