Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus
Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus
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DOI：
10.1016/j.jocn.2015.10.044
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发表时间：
2016-07-01
影响因子：
2
通讯作者：
Owler, Brian
中科院分区：
文献类型：
--
作者：
Shaw, Richard;Everingham, Emma;Owler, Brian
特发性正常压力脑积水是一种步态障碍、痴呆和尿失禁的综合征。由于缺乏可靠的定量结局数据和选择分流候选者的方法不一致，INPH脑室腹腔分流术后的结局是可变的。这项回顾性队列研究的目的是评估INPH脑室腹膜分流术的客观和定量临床结局。从2008年至2013年，根据临床和放射学标准诊断为INPH的连续患者被纳入本单中心研究。所有患者均接受了可编程阀脑室腹腔分流术。在基线、术后3、6和12个月评估结局指标。结果包括步态时间和统一帕金森病评定量表第三部分（CARS-III）、Addenbrooke认知检查修订版（ACE-R）和简易精神状态检查（MMSE）的评分。在最后一次随访时，将改善的阈值先验地设定为步态时间减少≥ 20%，MRS-III评分减少≥ 10分，ACE-R评分增加≥ 5分，MMSE评分增加≥ 2分。改善的患者比例在不同的测量指标之间存在差异，包括步态时间（60%）、MMSE-III（69%）、MMSE（63%）和ACE-R（56%）。总体而言，85%的患者至少有一项结局指标得到改善，38%的患者在步态时间、CARS-III评分和认知评分方面得到改善。只有15%的患者在任何指标上都没有改善。这项研究表明，大多数INPH患者在分流术后12个月内可以维持多种症状的改善。(c)2016爱思唯尔有限公司版权所有
Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of gait disturbance, dementia and urinary incontinence. Outcomes after ventriculoperitoneal shunting for INPH are variable due to a lack of reliable, quantitative outcome data and inconsistent methods of selecting shunt candidates. The aim of this retrospective cohort study was to assess objective and quantitative clinical outcomes of ventriculoperitoneal shunting for INPH. From 2008 to 2013, consecutive patients diagnosed with INPH based on clinical and radiological criteria were included in this single-centre study. All patients received programmable-valve ventriculoperitoneal shunts. Outcome measures were assessed at baseline, 3, 6 and 12 months post-operatively. Outcomes included gait time and scores on the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Addenbrooke's Cognitive Examination Revised (ACE-R) and the Mini-Mental State Examination (MMSE). Thresholds for improvements were set a priori as >= 20% decrease in gait time, >= 10 point decrease in UPDRS-III score, >= 5 point increase in ACE-R score and >= 2 point increase in MMSE score at last follow-up. The proportion of patients improving varied between measures, being gait time (60%), UPDRS-III (69%), MMSE (63%), and ACE-R (56%). Overall, improvement in at least one outcome measure was observed in 85% of patients and 38% improved in gait time, UPDRS-III score and cognitive scores. Only 15% of patients experienced no improvement on any measure. This study demonstrates that the majority of INPH patients can sustain improvements in multiple symptoms up to 12 months after shunting. (c) 2016 Elsevier Ltd. All rights reserved.