Hydrocephalus, Intracranial Pressure and Neurocognition

描述（由申请人提供）：脑积水，脑脊液（CSF）积聚在颅内间隙，是一种可引起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转移到脑外吸收表面得到很好的治疗，但颅内压升高和脑脊液压力动力学改变的短期和长期认知影响尚不完全清楚。该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的认知影响。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。具体而言，该建议的目的是：(1)确定操作新型可编程脑脊液分流阀后与ICP分级增加相关的认知功能急性变化；(2)确定分流故障治疗时颅内压（ICP）降低引起的认知功能变化；(3)确定脑积水伴导水管狭窄患者行脑脊液内分流术治疗后的认知功能缺损及治疗后改善情况；(4)在比较虹吸和非虹吸两种最常用的分流阀系统时，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一系列研究的对象，以解决上述具体目标。脑脊液压力动态将使用远程监测技术进行测量，该技术用于ICP的无创测量，该技术作为脑积水患者标准临床护理的一部分，在线植入脑脊液分流系统。治疗结果的确定将基于高级皮质功能的特定神经心理学测试。在脑积水模型中使用这种方法，我们将能够检查ICP变化对神经认知的影响，大概可以确定哪些认知功能是ICP“敏感”或ICP“抵抗”。在研究结论中，得出的数据也应该实际影响分流产品的手术选择。

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.