Takeuchi Totaro, Ishihara Tetsuya, Kubo Hitoshi, Izawa Naoki, Watanabe Chikako, Tanno Yoshihiro, Abe Yoshinori, Katayama Soichi, Goto Hiromi, Izaki Kenji, Kokubu Kohei, Oda Masaya, Ohmae Tomoya, Sasanuma Jin-ichi, Maeno Kazushige, Kikuchi Yasuhiro, Koizumi Jin-ichi, Watanabe Zen-ichiro, Ito Yasunobu, Ohara Hiroo, Kowada Masayoshi, Watanabe Kazuo
Department of Neurosurgery, The Southern Tohoku High Degree Medical Center, Southern Tohoku Research Institute for Neuroscience, Japan.
No To Shinkei. 2005 Apr;57(4):306-12.
The purpose of this study was to investigate the significance of the shunt-effect evaluation of SPECT in idiopathic normal pressure hydrocephalus (iNPH).
The subjects were 15 patients with possible iNPH, aged 62-83 (mean 75.3, the ratio of males to females to 6:9), who were treated at our department during the period from June to September, 2004. All patients received the lumbar tap test (LTT) at the outpatient section before surgery. An L-P shunt was conducted on patients whose the LTT positive or negative with cerebrospinal fluid outflow resistance value (Ro) was 10 mmHg/ml/min. or higher patients. As for SPECT, a 3D-SSP Z-score, as well as an mCBF, was conducted before and after the LTT and within one month after surgery. Comparisons were made for (1) the shunt effect, (2) mCBF before and after the LTT and after surgery, (3) mean cerebral blood flow increase rate (mIR) after the LTT, and (4) 3D-SSP before and after surgery.
(1) The shunt was effective for all the patients. (2) The mCBF levels was 30.8 +/- 4.02 ml/100 g/min. before the LTT, 37.1 +/- 100 g/min. after the LTT, and 38.6 +/- 3.4 ml/100 g/min. after surgery. A significant increase in mCBF was observed both after the LTT and after surgery (p < 0.05). (3) The mean mIR after the LTT was 21.2 +/- 8.01%, with all the patients showing 10% or higher. (4) The ischemic patterns in the SD-SSP Z-score before surgery were the frontal type (F: 10 cases, 66.7%), the occipitotemporal type (OT: 3 cases, 20%), and the mixed type (M: 2 cases, 13.3%), but not the parietal localized type. The post-operative course showed no-change in 4 cases, disappearance-reduction in 9 cases, and shift to OT in 2 cases.
The evaluation factors in the measurement of the cerebral blood flow for evaluation of the shunt effect were the following two items. (1) The mIR of mCBF after the LIT was 10% or higher. (2) As for the preoperative cerebral ischemic patterns, there were many F cases and no parietial localized types found.
本研究旨在探讨单光子发射计算机断层扫描（SPECT）分流效应评估在特发性正常压力脑积水（iNPH）中的意义。
研究对象为2004年6月至9月期间在我科接受治疗的15例疑似iNPH患者，年龄62 - 83岁（平均75.3岁，男女比例为6:9）。所有患者在手术前于门诊接受腰椎穿刺试验（LTT）。对LTT阳性或阴性且脑脊液流出阻力值（Ro）为10 mmHg/ml/min或更高的患者进行腰大池-腹腔分流术（L-P分流）。对于SPECT，在LTT前后及手术后1个月内进行三维立体定位表面投影（3D-SSP）Z评分以及脑血流量（mCBF）测定。比较内容包括：（1）分流效果；（2）LTT前后及手术后的mCBF；（3）LTT后脑血流量平均增加率（mIR）；（4）手术前后的3D-SSP。
（1）所有患者分流均有效。（2）LTT前mCBF水平为30.8±4.02 ml/100g/min，LTT后为37.1±100g/min，手术后为38.6±3.4 ml/100g/min。LTT后及手术后mCBF均显著增加（p<0.05）。（3）LTT后平均mIR为21.2±8.01%，所有患者均显示增加10%或更高。（4）手术前SD-SSP Z评分的缺血模式为额叶型（F：10例，66.7%）、枕颞型（OT：3例，20%）和混合型（M：2例，13.3%），无顶叶局限性型。术后病程中，4例无变化，9例消失-减轻，2例转变为OT型。
用于评估分流效果的脑血流量测量中的评估因素为以下两项。（1）LIT后mCBF的mIR为10%或更高。（2）术前脑缺血模式中，F型病例较多，未发现顶叶局限性型。
