Current research of idiopathic normal pressure hydrocephalus:Pathogenesis,diagnosis and treatment

Idiopathic normal pressure hydrocephalus(iNPH)is caused by impaired cerebrospinal fluid absorption in the elderly;it is a surgically treatable form of dementia.Gait disturbance,dementia,and urinary incontinence are the triad of signs for iNPH.In addition to these clinical findings,imaging studies show characteristic ventricular enlargement.High Evans Index and‘disproportionately enlarged subarachnoid hydrocephalus’are other well-known imaging findings of iNPH.If the tap test shows improved symptoms,shunt surgery is performed.The disease was first described by Hakim and Adams in 1965,followed by the publication of the first,second,and third editions of the guidelines in 2004,2012,and 2020,respectively.Recent studies signal the glymphatic system and classical cerebrospinal fluid(CSF)absorption from the dural lymphatics as aetiological mechanisms of CSF retention.Research is also underway on imaging test and biomarker developments for more precise diagnosis,shunting technique options with fewer sequelae and complications,and the influence of genetics.Particularly,the newly introduced‘suspected iNPH’in the third edition of the guidelines may be useful for earlier diagnosis.However,less well-studied areas remain,such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs.This review briefly presents previous research on these and future issues.

Management of Idiopathic Chronic Hydrocephalus of the Adult in Guinea: A Prospective Study in 16 Patients

Object: Incidence of Idiopathic chronic hydrocephalus of the adult (ICHA) is increasing in Guinea due to the aging of the population. The goal of this study was to describe its epidemiology, clinical presentation, and surgical outcome in a low-resource medical environment. Method: Sixteen patients operated for a probable ICHA were prospectively studied according to a uniform protocol from June 2019 to December 2020. On computerized tomography, all operated patients had a clinical triad of gait disturbance, incontinence, dementia associated with ventriculomegaly, and transependymal edema. In addition, all patients underwent a single lumbar tap, improved clinically, and were subsequently offered a shunt consisting of a simple catheter in 37.5% and a non-adjustable high-pressure valve in 62.5%. Result: The mean age was 68.31 ± 10.4 (range 49 - 89). The sex ratio H/F was 1.67/1. Clinically, the most frequent comorbidity was a combination of hypertension and diabetes in 56.5% of cases. The mean time to diagnosis was 8.31 ± 2.75 months (range 3 - 14). The immediate postoperative mortality was 12.5% from a status epilepticus and pulmonary sepsis. In addition, we observed 2 cases of chronic subdural hematoma (12.5%) and 2 cases of shunt dysfunction (12.5%) in the first three months. The functional outcome was good in 23% of patients at one month (N = 13), 50% at three months (N = 10), and 87.5% at six months (N = 8). Conclusion: In carefully selected cases, the surgical outcome of ICHA in Guinea is comparable to high-income countries. Efforts need to be put in helping patients get covered with universal insurance and generally promote Neurosurgery in the country to improve the quality of care.

Tap试验阴性老年iNPH患者行腰大池置管脑脊液压力持续检测的可行性和必要性

目的:研究腰椎穿刺脑脊液放液试验(Tap试验)阴性老年特发性正常压力脑积水(iNPH)患者行腰大池置管脑脊液压力持续检测的可行性和必要性。方法:回顾性分析2017年1月—2022年7月北京市昌平区医院收治的86例Tap试验阴性老年i NPH患者的资料,所有患者均在Tap试验后行腰大池置管引流术+脑脊液压力测试,然后行脑室-腹腔(VP)分流术治疗,根据不同预后将86例患者分为预后良好组(n=37)和预后不良组(n=49),根据脑脊液压力(CSFP)与颅内压相关系数(RAP)两者联合诊断最佳截断值分为A组(n=35)与B组(n=51)。比较Tap试验阴性老年iNPH患者VP分流术前后简易精神状态评价量表(MMSE)评分、计时-起立-行走测试(TUGT)时间和排尿评分,比较不同预后患者相关指标,绘制ROC曲线分析CSFP、RAP及两者联合预测Tap试验阴性老年iNPH患者VP分流术预后的价值,比较A组和B组步态不稳、认知障碍、排尿障碍改善率。结果:Tap试验阴性老年iNPH患者VP分流术后1个月MMSE评分高于术前,TUGT时间短于术前,排尿评分低于术前,差异有统计学意义(P<0.05)。预后良好组CSFP、RAP均高于预后不良组,差异有统计学意义(P<0.05);两组性别、平均年龄、Hakim三联征症状构成比较,差异无统计学意义(P>0.05)。两者联合诊断曲线下面积(AUC)大于CSFP、RAP单独诊断,差异有统计学意义(P<0.05)。A组术后1个月步态不稳、认知障碍及排尿障碍改善率均高于B组,差异有统计学意义(P<0.05)。结论:Tap试验阴性老年iNPH患者行腰大池置管脑脊液压力持续检测,通过CSFP、RAP可反映脑室内与周围组织对压力梯度的代偿能力和耐受能力,CSFP、RAP越大,VP分流术的效果越好。

睡眠性状与特发性正常压力脑积水的因果关联:一项两样本双向孟德尔随机化研究

目的利用双向孟德尔随机化研究方法探索睡眠性状与特发性正常压力脑积水之间的因果关系。方法采用GWAS catalog、芬兰公共数据库和MRCIEU GWAS数据库中8种睡眠性状的全基因组关联分析数据作为暴露,芬兰公共数据库中特发性正常压力脑积水(iNPH)的全基因组关联分析数据作为结局,使用逆方差加权法(IVW)作为主分析方法来评估睡眠性状与特发性正常压力脑积水之间的因果关系。敏感性分析方法采用Cochrane Q检验进行异质性检验和采用MR Egger‑intercept检验来检测潜在的水平多效性。同时,进行反向孟德尔随机化分析特发性正常压力脑积水与睡眠性状的因果关联。结果主分析方法IVW法显示经常白天小睡会增加iNPH的发病风险(OR=3.3393,95 CI%:1.0646-10.4742,P=0.0270)。Cochrane Q检验显示结果无潜在的异质性、MR Egger‑intercept检验显示结果无水平多效性(P>0.05)。外部验证复现了这一结果(OR=2.5660,95 CI%:1.1680-5.6373,P=0.0189)、(OR=4.0424,95 CI%:1.5709-10.4024,P=0.0038)。反向MR分析提示罹患iNPH不会影响睡眠性状。结论白天小睡的频率和特发性正常压力脑积水存在因果关联,对于老年人群,减少每周白天小睡的频率有助于降低iNPH的发生风险。

56例特发性正常压力脑积水患者的临床和MRI特征分析

目的:对行手术确诊的特发性正常压力脑积水患者的临床和MRI表现进行分析和总结,研究其临床、MRI特征以提高对该疾病的认识。方法:回顾性分析56例行分流术确诊的特发性正常压力脑积水(iNPH)患者临床和术前MR(包括3DT1WI、T2WI、T2 FLAIR)资料,对iNPH常见MR影像征象进行评估和描述。结果:56例iNPH患者中,步态障碍、认知障碍及尿失禁的发生率分别为91.1%、60.7%及42.9%,经典三联征为23.2%;常见合并症依次为高血压(51.8%)、糖尿病(28.6%)及帕金森病(PD)(12.5%)。对56例iNPH患者MR图像进行分析,82.1%患者胼胝体角呈锐角,39.3%患者蛛网膜下腔不成比例扩大征象(DESH)阳性,DESH评分平均得分(5.24±1.27)。结论:iNPH确诊患者最常合并高血压、糖尿病和PD,经典三联征较少,典型的MR征象阳性率不高,阴性患者的诊断和预后预测仍然存在挑战,应结合其他临床检查明确诊断和治疗。

特发性正常压力脑积水的诊疗进展

特发性正常压力脑积水(iNPH)多见于老年人,以步态障碍、认知障碍和尿失禁三联征为特征,与脑室扩大有关但脑脊液压力正常。早期诊断识别通过脑脊液分流手术可以有效改善症状,但由于诊断复杂,临床易漏诊和误诊。近二十年来,iNPH的诊断和治疗方式不断更新和改善,促进了规范诊疗,有利于提高患者的生活质量。本文对iNPH的流行病学、诊断和治疗现状以及新发现、新观点作一述评,旨在为临床医师诊疗iNPH患者提供参考和借鉴。

虚拟现实训练对老年特发性正常压力脑积水患者平衡与步行功能的影响

目的观察虚拟现实(VR)训练对老年特发性正常压力脑积水患者平衡与步行功能的影响。方法2022年9月至2023年7月,复旦大学附属华东医院收治的特发性正常压力脑积水患者38例,随机分为对照组(n=19)和观察组(n=19)。两组均接受常规康复训练,观察组增加VR训练,共4周。干预前后,采用功能性伸展测试(FRT)、Berg平衡量表(BBS)、静态平衡功能测试(反应时间、移动速度、方向控制、最大偏移距离、端点行程)、计时起立-行走测试(TUGT)和双任务计时起立-行走测试(DTUGT)进行评估。结果干预后,两组各项指标均显著改善(|t|>6.563,P<0.001);除TUGT外,其余指标观察组均优于对照组(|t|>2.038,P<0.05)。结论增加VR训练可以进一步改善特发性正常压力脑积水患者的平衡与步行功能。

老年特发性正常压力脑积水患者的姿势稳定性特征

背景:姿势控制能力受损是特发性正常压力脑积水患者发生跌倒、引发继发性损害的重要危险因素,现有研究大多是对患者直线行走时的步态参数进行分析,鲜有对患者在静态与动态活动中的姿势稳定性特征进行分析。目的:分析老年特发性正常压力脑积水患者的姿势稳定性特征。方法:选择2022年9月至2023年2月在上海市复旦大学附属华东医院神经外科临床诊断为特发性正常压力脑积水的患者22例作为患者组,同时选择健康陪诊家属18名作为健康对照组。分别采用计时起立-行走测试、多方向性伸展测试、Berg平衡量表和静态平衡功能测试(反应时间、移动速度、方向控制、最大偏移距离、端点行程)评估受试者的姿势稳定性特征。结果与结论:①患者组完成计时起立-行走测试所需时间及静态平衡功能测试的反应时间均长于健康对照组(P<0.05),前、后、左、右方向上的伸展测试手臂伸展距离均小于健康对照组(P<0.05),Berg平衡量表得分低于健康对照组(P<0.05),静态平衡功能测试的移动速度、方向控制、最大偏移距离和端点行程均小于健康对照组(P<0.05)。②结果提示,特发性正常压力脑积水患者表现出整体的姿势控制能力障碍,反应能力与执行能力受损使得这类患者在面对来自内部或外部的干扰时无法做出及时、准确的运动反应而出现姿势不稳,增加了发生跌倒的风险。

DESH征对iNPH手术预后诊断价值的Meta分析

目的系统评价蛛网膜下腔不成比例扩大的脑积水(disproportionately enlarged subarachnoid space hydrocephalus,DESH)征对特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,iNPH)手术预后的诊断价值。材料与方法计算机检索WanFang Data、CNKI、PubMed、The Cochrane Library、Web of Science和EMbase数据库,搜集DESH征诊断iNPH手术预后的诊断性试验,文献检索时限均从建库至2020年5月。由两名研究者按照纳入与排除标准进行独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险后,使用Meta-Disc 1.4软件进行Meta分析。结果共纳入5个研究,包括333例患者。Meta分析结果显示:DESH征诊断iNPH的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和绘制汇总受试者工作特征(summary receiver operating characteristics,SROC)曲线并计算曲线下面积分别为60%[95%CI(0.54,0.67)]、66%[95%CI(0.56,0.76)],1.87[95%CI(1.13,3.10)]、0.45[95%CI(0.23,0.88)]、4.91[95%CI(1.45,16.68)]和0.75。结论本研究系统评价DESH征对iNPH手术预后的诊断价值,尽管其仅具有中等诊断价值,但仍有比较重要的临床意义,因纳入研究较少,仍需开展更多研究予以证实,同时提醒临床工作者应重视影像学尤其是核磁共振检查在iNPH诊断中的意义。

特发性正常压力脑积水患者头颅MRI定量参数与认知功能、精神状态的相关性分析

目的:探究特发性正常压力脑积水(iNPH)患者头颅磁共振成像(MRI)定量参数与认知功能、精神状态的相关性。方法:以2017年1月—2023年1月贵溪市人民医院与南昌大学第二附属医院收治的iNPH患者86例为iNPH组,同期在以上医院进行健康体检的人群中选取50例作为对照组。全部研究对象均接受头颅MRI检查,并比较iNPH组和对照组的Evan’s指数、胼胝体夹角、灰质比、白质比。采用简易精神状态检查(MMSE)评估精神状态,采用蒙特利尔认知评估量表(MoCA)评估认知功能,探究MRI定量参数与精神状态、认知功能的相关性。结果:iNPH组的Evan’s指数、灰质比均显著高于对照组,胼胝体夹角、白质比均低于对照组,差异均有统计学意义(P<0.05);重度认知功能障碍组与轻度认知功能障碍组患者的Evan’s指数及胼胝体夹角比较,差异均无统计学意义(P>0.05);重度认知功能障碍组患者的灰质比显著高于轻度认知功能障碍组,白质比低于轻度认知功能障碍组,差异均有统计学意义(P<0.05);logistic回归分析显示,灰质比、白质比与iNPH患者的认知功能及精神状态无相关性(P>0.05)。结论:iNPH患者的MRI定量参数与健康人群存在显著差异,灰质比、白质比在认知功能、精神状态评估中有一定价值,但灰质比、白质比与认知功能、精神状态并无相关性。

特发性正常颅压性脑积水(iNPH)患者认知障碍特征的临床分析

目的对特发性正常颅压性脑积水(idiopathic normal pressure hydrocephalus,iNPH)患者的认知障碍特征进行临床分析,为临床诊疗提供依据。方法通过多个量表评价23例诊断为疑似iNPH患者的认知功能,对照组为15例性别年龄匹配、经磁共振明确无脑积水表现的病例。采用简易精神状态检查量表评价总体认知功能,Stroop色词测验评估执行功能,听觉词语学习测验评估学习和记忆功能,数字广度测验评估注意功能,改良Rankin量表和日常生活活动能力量表评价整体生活能力。结果本研究中iNPH患者(iNPH组)的简易精神状态检查量表评分[21.00 (11.00~25.00)]较对照组[28.00(26.00~29.00)]显著下降( P <0.01);Stroop色词测验中卡片A所耗秒数[59.60(33.60~97.70)]较对照组[32.00 (26.00~39.00)]显著延长( P =0.04),卡片A正确个数[50.00 (46.00~50.00)]较对照组(均为50个)显著下降( P =0.02),完成卡片B所耗秒数[106.00(59.20~227.60)]较对照组[46.00 (37.00~50.00)]显著延长( P <0.01),完成卡片A及B总耗秒数[177.70(90.00~279.40)]较对照组[75.00 (72.00~89.00)]显著延长( P <0.01),完成卡片C所耗平均秒数[206.60(99.50~237.10)]较对照组[88.00 (70.00~120.00)]显著延长( P =0.01);听觉词语学习测验中短延迟回忆平均个数,iNPH组(4.18±2.89)较对照组(6.29±2.14)显著下降( P =0.04),长延迟回忆个数[3.50(3.00~ 5.00 )]较对照组[7.00 (6.00~9.00)]显著下降( P =0.01),线索回忆个数[1.50(0.00~4.00)]较对照组[5.50 (3.00~9.50)]显著下降( P =0.02),平均回忆总个数(即前5次回忆个数之和)[15.00(11.00~23.00)]较对照组[24.00 (20.00~37.00)]显著下降( P =0.04);数字广度测验中倒背得分(3.04± 2.12 )较对照组(4.15± 0.99 )显著下降( P =0.03);改良Rankin评分[3.00 (2.00~4.00)]较对照组(均为0分)显著增高( P <0.01);ADL评分[85.00(70.00~95.00)]较对照组(均为100分)显著下降( P <0.01)。结论iNPH患者存在认知功能下降,表现为执行功能障碍、记忆损害、注意损害及日常生活能力下降。

持续腰大池置管脑脊液压力检测对Tap试验阴性iNPH患者的诊疗价值

目的探讨腰大池置管持续测定脑脊液压力对腰椎穿刺脑脊液放液试验(Tap试验)阴性的特发性正常压力脑积水(iNPH)患者的诊疗价值。方法选择82例Tap试验阴性的iNPH患者作为研究对象,持续12 h行腰大池置管脑脊液压力测定后行脑室—腹腔分流术。根据颅内压波幅与颅内压相关系数(RAP)值分为2组,RAP≥0.6的34例患者为高RAP组,RAP<0.6的48例患者为低RAP组。比较2组手术前后无障碍直线折返计时行走测试(TUGT)时间、简易精神评价测量表(MMSR)评分和排尿评分,评估2组患者步态不稳、认知障碍、排尿障碍改善率及治疗效果。结果术后1个月,高RAP组TUGT时间较术前及低RAP组明显缩短,MMSR评分较术前及低RAP组明显提高,排尿评分较术前及低RAP组明显降低,差异有统计学意义(P<0.05)。高RAP组术后1个月步态不稳、认知障碍、排尿障碍改善率高于低RAP组,差异有统计学意义(P<0.05)。高RAP组患者脑室—腹腔分流术后疗效总有效率高于低RAP组,差异有统计学意义(P<0.05)。结论Tap试验阴性的iNPH患者经持续12 h腰大池置管脑脊液压力测定再筛查,以RAP≥0.6作为行脑室—腹腔分流术的指标具有较高的诊疗价值。

Cognitive Impairment in Idiopathic Normal Pressure Hydrocephalus

Idiopathic normal pressure hydrocephalus(iNPH)is a significant cause of the severe cognitive decline in the elderly population.There is no cure for iNPH,but cognitive symptoms can be partially alleviated through cerebrospinal fluid(CSF)diversion.In the early stages of iNPH,cognitive deficits occur primarily in the executive functions and working memory supported by frontostriatal circuits.As the disease progresses,cognition declines continuously and globally,leading to poor quality of life and daily functioning.In this review,we present recent advances in understanding the neurobiological mechanisms of cognitive impairment in iNPH,focusing on(1)abnormal CSF dynamics,(2)dysfunction of frontostriatal and entorhinal-hippocampal circuits and the default mode network,(3)abnormal neuromodulation,and(4)the presence of amyloid-βand tau pathologies.

Cerebrospinal fluid biomarkers in idiopathic normal pressure hydrocephalus

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by abnormal cerebrospinal fluid (CSF) flow and consequent cerebral ventricular enlargement due to imbalance of CSF production and absorption. The typical triad symptoms, namely cognitive decline, gait disturbance, and urinary incontinence, are thought to be caused by disruption of CSF circulation. However, some patients may still experience symptomatic progression after functional shunting, suggesting that iNPH is far more complicated than a simple disorder of CSF circulation. Moreover, the diagnostic workup of iNPH can be challenging due to symptomatic and neuroimaging overlaps with other neurological disorders, such as Alzheimer's disease. Furthermore, accumulating studies indicate that the pathogenesis of iNPH might relate to multiple mechanisms, including abnormalities of brain development, brain extracellular matrix, synaptic function, blood flow, and cerebral metabolism. Therefore, iNPH is not an isolated entity in occurrence and development. Nevertheless, different pathogeneses may result in protein content changes in CSF, and the biomarkers in CSF may reflect the possible mechanisms involving the etiology of iNPH and are potentially useful in assisting the diagnosis and treatment selection. In this review, we summarize the main findings of CSF biomarkers and aim to outline a possible synthetic profile in assisting iNPH diagnosis and therapeutic options.

Radiological biomarkers of idiopathic normal pressure hydrocephalus:new approaches for detecting concomitant Alzheimer’s disease and predicting prognosis

Idiopathic normal pressure hydrocephalus(iNPH)is a clinical syndrome characterized by cognitive decline,gait disturbance,and urinary incontinence.As iNPH often occurs in elderly individuals prone tomany types of comorbidity,a differential diagnosis with other neurodegenerative diseases is crucial,especially Alzheimer’s disease(AD).A growing body of published work provides evidence of radiological methods,including multimodal magnetic resonance imaging and positron emission tomography,which may help noninvasively differentiate iNPH from AD or reveal concurrent AD pathology in vivo.Imaging methods detecting morphological changes,white matter microstructural changes,cerebrospinal fluid circulation,and molecular imaging have been widely applied in iNPH patients.Here,we review radiological biomarkers using different methods in evaluating iNPH pathophysiology and differentiating or detecting concomitant AD,to noninvasively predict the possible outcome postshunt and select candidates for shunt surgery.

特发性正常压力脑积水的病理生理机制研究进展

特发性正常压力脑积水(iNPH)是一种多见于老年人且病理生理机制不明的神经系统疾病,典型表现为步态障碍、认知障碍和膀胱功能障碍临床三联征,疾病标志是脑室系统扩大,但颅内压正常,脑脊液分流术可有效地改善症状。iNPH的病因、危险因素及病理生理机制尚未完全阐明,仍需进一步的研究。本文结合国内外文献,就iNPH的病理生理机制研究进展进行综述,以期为后续研究及临床诊疗提供一定的参考。

很可能的特发性正常压力脑积水患者淡漠、焦虑和抑郁症状特点分析

目的总结很可能的特发性正常压力脑积水(probable idiopathic normal pressure hydrocephalus,Probable iNPH)患者淡漠、焦虑、抑郁症状的出现率、严重程度和特点,通过增强对这些神经精神症状的认识,提高iNPH诊疗效率。方法收集自2017年3月至2021年3月就诊于航空总医院神经内科诊断为很可能的iNPH患者资料60例,进行改良淡漠评定量表(modified apathy evaluation scale,MAES)、宗氏焦虑自评量表(Zung self-rating anxiety scale,SAS)和抑郁自评量表(Zung self-rating depression scale,SDS)测定,分析淡漠、焦虑和抑郁症状的出现率、严重程度和特点。进一步根据有无淡漠、焦虑和抑郁症状,分别将患者分为有无淡漠组、有无焦虑组和有无抑郁组,分别对比分析有无上述症状患者的临床特点。结果53例很可能的iNPH患者纳入研究,男37例、女16例。出现淡漠症状33例(62.3%),焦虑症状14例(26.4%),抑郁症状15例(28.3%),以出现轻度焦虑和抑郁症状比例最大。进一步按照有无淡漠、有无焦虑和有无抑郁分组分析显示,淡漠组患者北京版蒙特利尔认知测验(Montreal cognitive assessment,MoCA)量表得分低于无淡漠组〔(15.1±5.8)分比(18.7±5.8)分,t=2.15,P=0.04〕;焦虑组患者SDS量表得分高于无焦虑组〔(53.6±12.3)分比(37.0±11.6)分,t=-4.52,P<0.001),病程短于无焦虑组〔24.0(12.0,27.0)个月比36.0(18.0,60.0)个月,Z=-2.20,P=0.03〕;抑郁组患者SAS和MAES量表得分均高于无抑郁组〔分别(48.0±12.9)分比(32.6±10.9)分,t=-4.41,P<0.001;(20.3±8.1)分比(15.0±5.1)分,t=2.90,P<0.001〕。结论淡漠、焦虑和抑郁症状在很可能的iNPH患者中出现率较高,以淡漠出现率最高(62.3%);抑郁和焦虑症状严重程度多为轻度损害;淡漠、焦虑和抑郁症状之间存在相互影响。通过常用量表有利于对这些特征进行识别,提高iNPH诊疗效率。

腰大池-腹腔分流术治疗正常压力脑积水的临床分析

目的总结腰大池-腹腔分流（LPS）术治疗特发性正常压力脑积水（iNPH）的疗效及优点。方法回顾性分析采用可调压分流管行LPS术治疗33例特发性正常压力脑积水（iNPH）病人的临床资料,主要临床表现有步态障碍、认知障碍和尿失禁,并分别采用5 m折返行走试验、简易智能精神状态检查（MMSE）和问卷调查方法对其进行评估。脑脊液放液试验阳性者作为手术治疗的必备条件,Evan’s指数评估手术前后脑室系统变化。结果本组脑脊液放液试验24 h内5 m折返行走试验阳性21例,24~72 h内阳性12例。术后随访6~24个月,多数病人临床症状不同程度好转。术前平均MMSE评分（24.8±2.8）分,术后6个月（26.2±2.5）分,两者差异显著（P〈0.05）;平均Evan’s指数术前为0.39±0.04,术后6个月为0.38±0.04,两者无显著差异（P=0.3137）。本组无死亡、术后感染和分流管堵塞等并发症。结论 LPS是治疗iNPH的有效方法,具有创伤小、恢复快、并发症少等优点。

脑室腹腔合流术治疗特发性正常颅压脑积水

目的：探讨特发性正常颅压脑积水(INPH)的诊断和手术治疗标准。方法：应用二级预测试验,作为是否选择手术治疗的标准,采用脑室腹腔分流手术治疗INPH 25例。结果：无手术死亡病例,未出现分流管排异反应、分流管堵塞、感染等现象。随访1～4年,总体改善率达92%。结论：应用二级预测试验,作为选择手术的标准,具有良好的阳性预测率,在临床上可靠易行。根据脑脊液压力选择分流管类型也很关键。

腰大池腹腔分流术与脑室腹腔分流术治疗特发性正常压力脑积水的临床疗效及安全性研究

目的比较腰大池腹腔分流(lumboperitoneal shunt,LPS)与脑室腹腔分流(ventriculoperitoneal shunt,VPS)治疗特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,i NPH)的临床疗效和安全性。方法特发性正常压力脑积水并行分流手术病人96例,按术式分为行腰大池腹腔分流术组(LPS组)和脑室腹腔分流术组(VPS组),LPS组28例,VPS组68例。比较两组病人治疗前后临床症状、预后评分及并发症发生率。结果治疗后LPS组和VPS组步态不稳分别为60. 0%和63. 5%,认知障碍分别为54. 2%和57. 9%,尿失禁分别为44. 4%和47. 7%,两组比较差异均无统计学意义(P> 0. 05); LPS组和VPS组改良Rankin量表(modified Rankin Scale,mRS)评分分别为(-0. 9±0. 5)和(-1. 0±0. 9),两组比较差异无统计学意义(P> 0. 05)。LPS组和VPS组并发症发生率分别为17. 9%和16. 2%,两组比较差异无统计学意义(P> 0. 05)。结论 LPS和VPS治疗i NPH的疗效和安全性相似,但LPS可以避免脑室穿刺造成的脑实质出血。