Extended Long-Term (> 5 Years) Outcome of Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus
Extended Long-Term (> 5 Years) Outcome of Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus
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DOI：
10.1227/01.neu.0000371972.74630.ec
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发表时间：
2010-08-01
期刊：
影响因子：
4.8
通讯作者：
Krauss, Joachim Kurt
中科院分区：
文献类型：
--
作者：
Mirzayan, Mohammad Javad;Luetjens, Goetz;Krauss, Joachim Kurt
背景技术背景：分流手术已被确立为唯一持久和有效的治疗特发性正常压力脑积水。目的：我们评估了“延长”长期随访（> 5年）在一项前瞻性研究队列谁接受分流1990年和1995年之间。一个次要目标是确定这些patients.METHODS的死亡原因：51例患者被纳入后，通过广泛的临床和诊断调查的诊断确认。手术包括在大多数患者中使用压差阀进行脑室心房或脑室腹膜分流。对于每一个主要症状，术后结果分别与克劳斯改善指数进行评估，产生一个值之间的0（没有好处）和1（最佳效益）的整体outcome.RESULTS：平均年龄为70.2岁（范围，50-87岁）。30例患者为女性，21例为男性。50例患者获得短期（18.8 +/- 16.6个月）随访。克劳斯改善指数为0.66 +/- 0.28。34例患者获得了长期（80.9 +/- 51.6个月）随访。克劳斯改善指数为0.64 +/- 0.33。29例患者在长期随访期间死亡，平均年龄为75.8岁（范围：55-95岁）。主要死亡原因为心血管疾病：心力衰竭（n = 7）和脑缺血（n = 12）。其他原因为肺炎（n = 2）、急性呼吸窘迫综合征（n = 1）、肺栓塞（n = 1）、癌症（n = 2）、肾衰竭（n = 1）和未知（n = 3）。无分流相关死亡率。结论：当采用严格的选择标准时，特发性正常压力脑积水患者可能会从分流术中长期受益。分流相关死亡率可忽略不计。死亡的主要原因是血管并发症。
BACKGROUND: Shunt surgery has been established as the only durable and effective treatment for idiopathic normal pressure hydrocephalus.OBJECTIVE: We evaluated the "extended" long-term follow-up (> 5 years) in a prospective study cohort who underwent shunting between 1990 and 1995. A secondary objective was to determine the cause of death in these patients.METHODS: Fifty-one patients were included after confirmation of the diagnosis by extensive clinical and diagnostic investigations. Surgery included ventriculoatrial or ventriculoperitoneal shunting with differential pressure valves in the majority of patients. For each of the cardinal symptoms, postoperative outcome was assessed separately with the Krauss Improvement Index, yielding a value between 0 (no benefit) and 1 (optimal benefit) for the overall outcome.RESULTS: Mean age at surgery was 70.2 years (range, 50-87 years). Thirty patients were women, and 21 were men. Short-term (18.8 +/- 16.6 months) follow-up was available for 50 patients. The Krauss Improvement Index was 0.66 +/- 0.28. Long-term (80.9 +/- 51.6 months) follow-up was available for 34 patients. The Krauss Improvement Index was 0.64 +/- 0.33. Twenty-nine patients died during the long-term follow-up at a mean age of 75.8 years (range, 55-95 years). The major causes of death were cardiovascular disorders: cardiac failure (n = 7) and cerebral ischemia (n = 12). Other causes were pneumonia (n = 2), acute respiratory distress syndrome (n = 1), pulmonary embolism (n = 1), cancer (n = 2), renal failure (n = 1), and unknown (n = 3). There was no shunt-related mortality.CONCLUSION: Idiopathic normal pressure hydrocephalus patients may benefit from shunting over the long term when rigorous selection criteria are applied. Shunt-related mortality is negligible. The main cause of death is vascular comorbidity.