Krauss J K, Halve B
Department of Neurosurgery, University Hospital, Klinikum Mannheim, Mannheim, Germany.
Acta Neurochir (Wien). 2004 Apr;146(4):379-88; discussion 388. doi: 10.1007/s00701-004-0234-3. Epub 2004 Feb 27.
There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH.
Standardized questionnaires with sections on the incidence of NPH and the frequency of shunting, evaluation of clinical symptoms, and signs, diagnostic studies, therapeutic decision-making and operative techniques, postoperative outcome and complications, and the profiles of different centers, were sent to 82 neurosurgical centers in Germany known to participate in the care of patients with NPH.
Data were analyzed from 49 of 53 centers which responded to the survey (65%). The estimated annual incidence of NPH was 1.8 cases/100.000 inhabitants. Gait disturbance was defined as the most important sign of NPH (61%). There was a wide variety in the choice of diagnostic tests. Cisternography was performed routinely only in single centers. Diagnostic CSF removal was used with varying frequency by all centers except one, but the amount of CSF removed by lumbar puncture differed markedly between centers. There was poor agreement on criteria for evaluation of continuous intracranial pressure recordings regarding both the amplitude and the relative frequency of B-waves. Both periventricular and deep white matter lesions were present in about 50% of patients being shunted, indicating that vascular comorbidity in NPH patients has gained more acceptance. Programmable shunts were used by more than half of the centers, and newer valve types such as gravitational valves have become more popular.
According to the present survey, new diagnostic and therapeutic concepts on NPH have penetrated daily routine to a certain extent. Wide variability, however, still exists among different neurosurgical centers.
对于选择正常压力脑积水（NPH）患者进行脑脊液分流的最佳诊断标准尚无共识。本研究的主要目的是对临床实践中的诊断算法和治疗决策进行当代调查。次要目的是估计NPH的发病率。
向德国已知参与NPH患者护理的82个神经外科中心发送标准化问卷，问卷内容包括NPH的发病率和分流频率、临床症状和体征评估、诊断研究、治疗决策和手术技术、术后结果和并发症以及不同中心的概况。
对53个回复调查的中心中的49个（65%）的数据进行了分析。NPH的估计年发病率为1.8例/10万居民。步态障碍被定义为NPH最重要的体征（61%）。诊断测试的选择差异很大。脑室造影仅在个别中心常规进行。除一个中心外，所有中心都不同频率地使用诊断性脑脊液引流，但各中心腰椎穿刺引流的脑脊液量差异显著。在连续颅内压记录的评估标准上，关于B波的幅度和相对频率的一致性较差。约50%接受分流的患者存在脑室周围和深部白质病变，这表明NPH患者的血管合并症已得到更多认可。超过一半的中心使用可编程分流器，新型阀门如重力阀越来越受欢迎。
根据本次调查，关于NPH的新诊断和治疗概念已在一定程度上渗透到日常实践中。然而，不同神经外科中心之间仍存在很大差异。
