Management of idiopathic normal-pressure hydrocephalus: a multiinstitutional study conducted in Japan
Management of idiopathic normal-pressure hydrocephalus: a multiinstitutional study conducted in Japan
复制标题
DOI：
10.3171/jns.2001.95.6.0970
复制
发表时间：
2001-12-01
影响因子：
4.1
通讯作者：
Mori, K
中科院分区：
文献类型：
--
作者：
Mori, K
Object.进行了一项合作研究，以确定可用于预测颅外脑脊液（CSF）分流术（疑似特发性正常颅压（NPH）患者分流术）后良好结局的因素。将关于疑似特发性NPH患者的研究报告发送给日本厚生省赞助的顽固性脑积水科学研究委员会的14名成员。在收回问卷后，对答复进行了回顾性分析。要纳入研究，患者必须年满65岁或以上，并且必须在1995年10月至1999年10月期间接受手术。临床指标包括在分流管置入前、3个月后和3年后评估的步态障碍、痴呆和尿失禁程度。各种诊断试验的组合包括腰椎穿刺，其中抽取脑脊液;颅内压监测;测量脑脊液流出阻力，血清α-1-抗糜蛋白酶水平，脑动静脉氧含量差异，脑血流量;和计算机断层脑池造影。在这项研究中，120例患者被确定为患有特发性NPH，这些患者接受了分流术。在三分之二的患者中使用了带可调压阀的脑室腹腔分流术。在3个月结束时（早期评估），临床改善的总体率为80%，在105例患者研究中降至73.3%。在三个变量中，步态障碍是最多的谁可以在3年的改善，无论是在早期和后期的测试阶段结束时进行评估。22例（18.3%）患者发生分流并发症。疑似患有特发性NPH的患者没有形成一个同质组，因此很难选择最有可能对CSF转移有反应的患者。在诊断研究中，最可靠的结果是。腰椎穿刺抽取CSF后临床症状改善。推荐使用可调压阀，因为它在防止过度引流和引流不足问题方面具有优势。
Object. A cooperative study was, undertaken to identify factors that could be used to predict a favorable outcome after extracranial cerebrospinal fluid (CSF) diversion (shunting in patients with suspected idiopathic normal-pressure by cephalus (NPH),.Methods. Questionnaires, concerning patients with suspected idiopathic NPH were sent to 14 members of the Committee for Scientific Research on Intractable Hydrocephalus, sponsored by the Ministry of Health and Welfare of Japan. After the questionnaires were returned, a retrospective analysis of the responses was undertaken. To be included in the study, patients had to be 65 years, of age or older and had to have undergone surgery between October 1995 and October 1999. Clinical measures included degrees of gait disturbance, dementia, and urinary incontinence as evaluated before, 3 months after, and 3 years after shunt placement. Diagnostic tests in various combinations included lumbar puncture in which CSF was withdrawn; intracranial pressure monitoring; measurements of CSF outflow resistance, level of serum alpha -1-antichymotrypsin, cerebral arteriovenous differences of oxygen content, and cerebral blood flow; and computerized tomography cisternography.In this study, 120) patients were identified as having idiopathic NPH and these patients underwent placement of shunts. A ventriculoperitoneal shunt with a programmable valve was used in two thirds of the patients. At the end of 3 months, (early assessment), there was, an 80% overall rate of clinical improvement, which dropped to 73.3% of the 105 patients study. Of the three variables, gait disturbance was most who could be evaluated at the end of the 3-year improved, both at early and late testing periods. Shunt complications occurred in 22 (18.3%) of the patients.Conclusions. Patients suspected of having idiopathic NPH did not form a homogeneous group, making it difficult to select those who would most likely respond to CSF diversion. Of the diagnostic studies, the most reliable result was. improvement in clinical symptoms following a lumbar puncture in which CSF was withdrawn. The use of a programmable valve is recommended because it offers advantages in preventing problems of over- and underdrainage.