成人特发性正常压力脑积水的外科治疗

The surgical treatment in adults with idiopathic normal pressure hydrocephalus

目的研究脑室腹腔分流术（VPS）治疗成人特发性正常压力脑积水的临床疗效。方法回顾北京协和医院2010年10月至2016年10月期间收治的特发性正常压力脑积水病例，汇总行VPS干预的患者资料，包括术前及术后随访的一般情况、脑积水评分及影像学资料等。结果共入组33例患者，同术前相比，术后3个月患者临床症状脑积水评分显著改善（3.0±1.0比6.0±2.5，P〈0.01）；术后6、12个月与术后3个月比较，临床症状脑积水评分差异无统计学意义。随访影像学资料显示Evans指数、三脑室宽度均有明显减小。1例患者发生硬膜下血肿，未发生感染及堵管等并发症，无死亡病例。结论VPS是治疗成人特发性正常压力脑积水的有效方法，多学科协作综合评估是诊断此病的关键和基础。

ObjectiveTo investigate the effect of Ventriculoperitoneal shunt （VPS）in adult patients with idiopathic normal pressure hydrocephalus （iNPH）.MethodsThe patients with idiopathic normal pressure hydrocephalus were reviewed, who were admitted into the Peking union medical college hospital from October 2010 to October 2016.The patients treated via VPS were retrospectively analyzed by collecting the data including clinic features, iNPH score and imaging data.Results33 patients were included in the group.3 months after operation, the iNPH scores were significantly decreased （3.0±1.0 vs 6.0±2.5, P〈0.01）, and there were no difference among 3 month, 6 month and 12 month post operation.The Evans index and the width of the three ventricles were also significantly decreased.1 patient suffered from subdural hematoma and no other complications such as infection, obstruction or death occurred.ConclusionsVPS is an effective treatment approach of iNPH and multidisciplinary team is the key in diagnosis.