Hydrocephalus, Intracranial Pressure and Neurocognition

脑积水、颅内压和神经认知

• 批准号: 6803018
• 负责人: DAVID MARTIN FRIM
• 金额: $ 28.98万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6803018
• 关键词: behavioral /social science research tag; cerebral ventricles; cerebrospinal fluid; clinical research; hydrocephalus; implant; intracranial pressure; magnetic resonance imaging; neuropsychological tests; neuropsychology; neurosurgery; patient monitoring device

DESCRIPTION (provided by applicant): Hydrocephalus, a build-up of cerebrospinal fluid (CSF) in the intracranial space, is a disease that can cause significant neurological injury. Although the associated life-threatening intracranial hypertension can be well treated by diversion of cerebrospinal fluid to an absorptive surface outside of the brain, the short- and longterm cognitive effects of elevated intracranial pressure and altered cerebrospinal fluid pressure dynamics are incompletely understood. The overall objective of this proposal is to determine the cognitive effects of changes in intracranial pressure and altered CSF pressure dynamics in a population of hydrocephalics. In addition, these studies may help to determine the pressures needed to optimize cognitive outcome in the treatment of hydrocephalus. Specifically, the aims of the proposal are: (1) to determine the acute changes in cognitive function associated with graded increases in ICP seen after manipulations of novel programmable CSF shunting valves; (2) to determine the changes in cognitive function caused by the lowering of intracranial pressure (ICP) at the time of treatment of malfunctioning shunts; (3) to determine the cognitive deficits and post-treatment improvement in the sub-population of hydrocephalics with aqueductal stenosis who are treated by an internal CSF bypass procedure; and (4) to determine the shunting pressure dynamic that optimizes cognitive function when comparing the two most commonly used shunting valve systems: those that siphon and those that do not. We propose enrolling hydrocephalic patients as subjects for a series of studies addressing the above specific aims. Cerebrospinal fluid pressure dynamics will be measured using telemonitoring technology for the non-invasive measurement of ICP which is implanted in-line in the CSF shunting system as part of the standard clinical care of the hydrocephalic patient. Treatment outcome determination will be based on specific neuropsychological tests of higher cortical function. With this approach in the hydrocephalus model, we will be able to examine the effects of ICP changes on neurocognition, presumably determining which cognitive functions are ICP "sensitive" or ICP "resistant". At the study conclusion, derived data should also practically affect the surgical choice of shunting products.

描述(申请人提供)：脑积水，脑脊液(CSF)积聚在颅内间隙，是一种可导致严重神经损伤的疾病。虽然相关的危及生命的颅内高压可以通过脑脊液分流到脑外的吸收表面得到很好的治疗，但颅内压升高和脑脊液压力动态变化对认知的短期和长期影响尚不完全清楚。这项建议的总体目标是确定脑积水人群中颅内压变化和脑脊液压力动态变化对认知的影响。此外，这些研究可能有助于确定在脑积水治疗中优化认知结果所需的压力。具体地说，该提案的目的是：(1)确定新型可编程脑脊液分流阀操作后与颅内压分级增加相关的认知功能的急剧变化；(2)确定在功能障碍的分流术治疗时，由于颅内压(ICP)降低而导致的认知功能变化；(3)确定接受脑脊液分流术治疗的脑积水合并导水管狭窄患者的认知障碍和治疗后的改善；以及(4)比较两种最常用的分流阀系统：虹吸式和非虹吸式分流阀系统，以确定优化认知功能的分流压力动态。我们建议招募脑积水患者作为研究对象，进行一系列针对上述特定目标的研究。脑脊液压力动态将使用远程监护技术进行无创性测量，将其植入脑脊液分流系统，作为标准临床护理的一部分。治疗结果的确定将基于特定的皮质功能较高的神经心理测试。在脑积水模型中采用这种方法，我们将能够检查颅内压变化对神经认知的影响，推测确定哪些认知功能是颅内压“敏感”的，哪些是“抵抗”的。在研究结论中，得出的数据也应该实际地影响分流产品的手术选择。