Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study
Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study
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DOI：
10.1186/1743-8454-7-18
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发表时间：
2010-10-31
影响因子：
7.3
通讯作者：
Kuwana, Nobumasa
中科院分区：
文献类型：
--
作者：
Hashimoto, Masaaki;Ishikawa, Masatsune;Kuwana, Nobumasa
背景：特发性正常压力脑积水（iNPH）是一种可治疗的老年神经系统综合征。尽管据报告，磁共振成像（MRI）发现的紧密高凸性和内侧蛛网膜下腔以及可调压阀脑室-腹腔（VP）分流分别可用于诊断和治疗，但其临床意义仍有待验证。我们进行了一项多中心前瞻性研究（特发性正常压力脑积水对神经改善的研究：SINPHONI），以评价基于MRI的诊断在确定使用Codman-Hakim可调压阀进行VP分流术后1年结局方面的效用。方法：本研究涉及日本的26家中心。年龄在60 - 85岁之间，有一种或多种症状（步态、认知和泌尿问题）和MRI证据显示脑室扩大和高凸度和内侧蛛网膜下腔狭窄的患者，使用基于身高/体重的瓣膜压力重置方案接受VP分流术。主要终点是术后1年时的有利结局（改良兰金量表：mRS改善1个或更多节段），次要终点包括iNPH分级量表总分改善1分或更多分。分流应答者定义为一年内任何评价点mRS上超过一个水平。结果：全分析集包括100例患者。69.0%和80.0%的分流反应者获得了有利结局。当使用iNPH分级量表测量时，1年改善率为77.0%，在任何评价点检测到89.0%的手术反应。15例患者记录了严重不良事件，其中3例事件与手术或VP分流相关。硬膜下积液和直立性头痛被报道为非严重的分流相关的不良事件，这是很好的控制与重新调整pressure.Conclusions：MRI为基础的诊断方案是非常有用的。狭窄的高凸性和内侧蛛网膜下腔，以及扩大的侧裂伴脑室扩大，定义为不成比例扩大的蛛网膜下腔脑积水（DESH），值得诊断iNPH。本研究已在ClinicalTrials注册。gov，编号NCT 00221091。
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable neurological syndrome in the elderly. Although the magnetic resonance imaging (MRI) findings of tight high-convexity and medial subarachnoid spaces and the ventriculo-peritoneal (VP) shunt with programmable valve are reportedly useful for diagnosis and treatment, respectively, their clinical significance remains to be validated. We conducted a multicenter prospective study (Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement: SINPHONI) to evaluate the utility of the MRI-based diagnosis for determining the 1-year outcome after VP shunt with the Codman-Hakim programmable valve.Methods: Twenty-six centers in Japan were involved in this study. Patients aged between 60 and 85 years with one or more of symptoms (gait, cognitive, and urinary problems) and MRI evidence of ventriculomegaly and tight high-convexity and medial subarachnoid spaces received VP shunt using the height/ weight-based valve pressuresetting scheme. The primary endpoint was a favorable outcome (improvement of one level or more on the modified Rankin Scale: mRS) at one year after surgery, and the secondary endpoints included improvement of one point or more on the total score of the iNPH grading scale. Shunt responder was defined by more than one level on mRS at any evaluation point in one year.Results: The full analysis set included 100 patients. A favorable outcome was achieved in 69.0% and 80.0% were shunt responders. When measured with the iNPH grading scale, the one-year improvement rate was 77.0%, and response to the surgery at any evaluation point was detected in 89.0%. Serious adverse events were recorded in 15 patients, three of which were events related to surgery or VP shunt. Subdural effusion and orthostatic headache were reported as non-serious shunt-related adverse events, which were well controlled with readjustment of pressure.Conclusions: The MRI-based diagnostic scheme is highly useful. Tight high-convexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly, defined as disproportionately enlarged subarachnoidspace hydrocephalus (DESH), are worthwhile for the diagnosis of iNPH. This study is registered with ClinicalTrials. gov, number NCT00221091.