Traczewski Wojciech, Moskała Marek, Szwabowska Dorota, Gościński Igor, Krupa Mariusz, Polak Jarosław
Klinika Neurotraumatologii, CMUJ, ul. Botaniczna 3, 31-503 Kraków.
Neurol Neurochir Pol. 2005 Jul-Aug;39(4):287-93.
It is generally agreed that the positive result of lumbar cerebrospinal fluid (CSF) withdrawal offers a reliable means for selection of patients likely to respond to shunting in normal pressure hydrocephalus (NPH). However the studies of cerebral hemodynamics in NPH are performed Routinely only in few neurosurgical centers. We therefore studied the effect of CSF withdrawal on cerebrovascular autoregulation (CVA) in this condition by means of computerized rheoencephalography [REG].
The study group consisted of 27 patients with presumed posttraumatic NPH. In each patient both the tap test and infusion test were performed. Psychometric tests and rheoencephalographic examinations were made twice: before and after CSF withdrawal. The obvious restoration of the functional state of CVA after CSF withdrawal was considered as a positive result of the tap test.
Fourteen patients with a positive tap test and/or with resistance to CSF outflow (Rout) of more than 11 mmHg/ml/min were shunted. The improvement was obtained in 10 of them. Only one patient with a positive tap test did not improve.
Our study suggests that restoration of CVA after CSF withdrawal is associated with high likelihood of shunt success, but not vice versa. Evaluation of CVA using REG seems to offer a new diagnostic tool in selecting patients likely to respond to shunting. Further studies are necessary to optimize the amount of CSF withdrawal, the delay between CSF withdrawal and control examinations and methodology of neuropsychological examinations.
人们普遍认为，腰椎脑脊液（CSF）引流结果呈阳性为筛选可能对正常压力脑积水（NPH）分流术有反应的患者提供了一种可靠方法。然而，NPH患者的脑血流动力学研究仅在少数神经外科中心常规开展。因此，我们通过计算机脑血流图描记术[REG]研究了CSF引流对这种情况下脑血管自动调节（CVA）的影响。
研究组由27例疑似创伤后NPH患者组成。对每位患者均进行了引流试验和灌注试验。心理测试和脑血流图检查在CSF引流前后各进行两次。CSF引流后CVA功能状态明显恢复被视为引流试验阳性结果。
14例引流试验阳性和/或脑脊液流出阻力（Rout）超过11 mmHg/ml/min的患者接受了分流术。其中10例病情得到改善。仅1例引流试验阳性患者病情未改善。
我们的研究表明，CSF引流后CVA恢复与分流成功的可能性高相关，但反之则不然。使用REG评估CVA似乎为筛选可能对分流术有反应的患者提供了一种新的诊断工具。有必要进一步研究以优化CSF引流量、CSF引流与对照检查之间的间隔时间以及神经心理学检查方法。
