Bech-Azeddine R, Gjerris F, Waldemar G, Czosnyka M, Juhler M
University Clinic of Neurosurgery, The Neuroscience Center, Rigshospitalet, H:S, Copenhagen, Denmark.
Acta Neurochir (Wien). 2005 Oct;147(10):1027-35; discussion 1035-6. doi: 10.1007/s00701-005-0589-0. Epub 2005 Aug 1.
To investigate the therapeutic consequences of restricting the CSF dynamic evaluation to a lumbar infusion test (LIT), as opposed to our formerly applied intraventricular assessment (VIT), in patients with communicating hydrocephalus (CH).
All patients over 18 years of age referred with clinical and radiological indication of treatment-requiring secondary CH (n = 50) or idiopathic normal-pressure hydrocephalus (INPH, n = 33) were subjected to a LIT. Subsequently, a combination of the results of the LIT (mainly the resistance to CSF outflow) and the clinical presentation determined whether to proceed with (a) VIT before a decision about shunt surgery, (b) shunt surgery or (c) no further diagnostic investigation or surgery.
In 88 percent of the patients with secondary CH and 80 percent of the patients with INPH the decision on shunt surgery was made after performing exclusively a LIT. The shunting success rate was 90 percent in patients with secondary CH and 82 percent in patients with INPH, which however in the latter group decreased to 76 percent, when including the patients undergoing an additional VIT. The achieved shunt success rates are equal or better, compared to the results from previous studies using intraventricular assessment.
LIT and VIT are equally reliable for selecting shunt responsive patients with CH, using clinical improvement rate as the main criterion for comparison. The practical and economic consequences are substantial: the LIT can be performed in an outpatient setting, whereas VIT necessitates hospitalisation for 1-2 days including occupation of the neurosurgical theatre and postoperative neuro-intensive monitoring.
探讨在交通性脑积水（CH）患者中，将脑脊液动力学评估局限于腰椎灌注试验（LIT）而非我们之前应用的脑室内评估（VIT）的治疗效果。
所有年龄超过18岁、因临床和影像学表现提示需要治疗的继发性CH（n = 50）或特发性正常压力脑积水（INPH，n = 33）而转诊的患者均接受LIT。随后，结合LIT的结果（主要是脑脊液流出阻力）和临床表现来决定是否进行以下操作：（a）在决定是否进行分流手术前进行VIT；（b）进行分流手术；（c）不再进行进一步的诊断性检查或手术。
在88%的继发性CH患者和80%的INPH患者中，仅进行LIT后就做出了分流手术的决定。继发性CH患者的分流成功率为90%，INPH患者为82%，然而，在后者中，若将接受额外VIT的患者包括在内，该成功率降至76%。与之前使用脑室内评估的研究结果相比，所取得的分流成功率相同或更高。
以临床改善率作为主要比较标准时，LIT和VIT在选择对分流有反应的CH患者方面同样可靠。实际和经济影响很大：LIT可在门诊进行，而VIT需要住院1 - 2天，包括占用神经外科手术室和术后神经重症监护。
