Basic and Clinical Study of Morphological and Functional Changes in Brainstem and Cerebellum in the Cases with Disturbances in Dynamics of Cerebrospinal Fluid Circulation

对14例诊断为正常压力性脑积水的患者（平均年龄74.8岁）进行围手术期智力测验。分流的判定标准为：1)NPH≥2例，2)脑室增大，3)CTC≥iib - v, 4) ICP监测b波率≥35%，5)手术及全身麻醉风险不高。所有病例均行分流术。手术智力测验结果良好4例，一般4例，无变化4例，恶化2例。分析了7例（平均年龄66岁）正常压力性脑积水的CT、MRI、CT脑池造影及脑血流量测定。所有病例均行V-P分流术。5例术后症状得到改善。脑室严重肿大、脑室周围白质及额叶皮质CBF较低、颅内压监测异常波频率较高的患者经手术治疗后有改善趋势。我们对124例脑积水患者（平均年龄35.5岁）进行了回顾性研究。45例患者只进行了单次分流手术。49名患者需要修改分流管。即使不符合CTC或ICP监测试验标准，也有部分患者术后症状得到改善。脑脊液动力学试验分析临床症状在分流手术决策中的应用有待进一步研究。

Perioperatively intelligence tests were performed in fourteen cases (mean age of 74.8 years) that were diagnosed normal pressure hydrocephalus. Criteria for shunts were, 1) mar than two of trias of NPH, 2) ventriculomegaly, 3) IIIb-V in CTC, 4) rate of B-wave was more than 35% in ICP monitoring, 5) not high risk of operation and general anesthesia. All cases were performed shunts. Surgical results of intelligence tests were good in four cases, fair in four cases, no change in four cases and deteriorated in two cases.CT, MRI, CT cisternography, and cerebral blood flow measurement were analyzed in seven cases (mean age of 66 years) of normal pressure hydrocephaly. V-P shunts were performed in all ases. Postopretave symptoms were improved in five cases. There were tendencies of improvement after sugical treatments in cases which had severe ventriculomegaly, low CBF in periventricular white matter and cortex of frontal lobe, and higher frequency of abnormal waves in ICP monitoring.We performed a retrospective study in 124 patients (mean age of 35.5 years) of hydrocephalus. Forty-five patients were performed only single shunt operations. Forty-nine patients required the revisions of their shunts. The postoperative symtopms were improved in some cases even if they didn't fill the criteria of CTC or ICP monitoring test. Further investigation is required in analyzing clinical symptom with cerebrospinal fluid dynamic test in decision making for shunt operation.