Shunt surgery in patients with hydrocephalus and white matter changes
Shunt surgery in patients with hydrocephalus and white matter changes
复制标题
DOI：
10.3171/2010.11.jns10967
复制
发表时间：
2011-05-01
影响因子：
4.1
通讯作者：
Wikkelso, Carsten
中科院分区：
文献类型：
--
作者：
Tisell, Magnus;Tullberg, Mats;Wikkelso, Carsten
Object.特发性正常压力脑积水（iNPH）患者通常表现为步态和认知功能受损，同时伴有脑室扩大和正常颅内压。许多患者有血管危险因素，MR成像显示脑室周围和深部白色物质改变。脑脊液动力学异常，即脑脊液流出阻力高或引流后改善，表明分流术效果良好。作者检查了最差情况iNPH患者（伴有广泛血管性白色病变且CSF动力学正常）是否会从分流术中获益。这些患者也符合Binswanger病的标准。因此，进行随机对照双盲研究。14名符合上述标准的连续患者被随机分配接受开放式或闭合式分流。术后3个月，最初结扎分流管的患者打开了分流管。术前、术后3个月和6个月分别进行7次定量心理测试和6次连续步态测试。随机接受开放分流术的患者在分流术放置后3个月的运动（增加30%）和心理测量（增加23%）评分有所改善。这些患者在3个月和6个月随访之间没有显著变化。相反，最初结扎分流的患者在最初的3个月内没有变化，尽管他们在去除结扎后运动功能（28%）和认知功能（18%）都有所改善。脑室扩大、脑积水症状和广泛血管白色物质改变的患者可从分流术中获益。(DOI：10.3171/2010.11.JNS10967）
Object. Patients with idiopathic normal pressure hydrocephalus (iNPH) often present with impaired gait and cognition together with ventricular enlargement and normal intracranial pressure. Many have vascular risk factors as well as periventricular and deep white matter changes on MR imaging. Abnormal CSF dynamics, that is, high resistance to outflow or improvement after CSF drainage, indicate good effects of shunt surgery. The authors examined whether the worst-case iNPH patients with extensive vascular white matter disease and normal CSF dynamics would benefit from shunt surgery. These patients also fulfilled the criteria for Binswanger disease. Therefore, a randomized controlled double-blind study was performed.Methods. Fourteen consecutive patients fulfilling the above criteria were randomized to receive either open or closed shunts. At 3 months after surgery, the patients with initially ligated shunts had their shunts opened. Clinical evaluation consisting of 7 quantitative psychometric and 6 continuous gait tests was performed preoperatively and 3 and 6 months after surgery.Results. Patients randomized to receive open shunts had improved motor (30% increase) and psychometric (23% increase) scores 3 months after shunt placement. There were no significant changes between the 3- and 6-month follow-up in these same patients. Conversely, those with initially ligated shunts were unchanged during the first 3-month period, although they improved in both motor (28%) and cognitive (18%) functions following removal of the ligature.Conclusions. Patients with enlarged ventricles, hydrocephalic symptoms, and extensive vascular white matter changes benefit from shunt surgery. (DOI: 10.3171/2010.11.JNS10967)