Kahlon Babar, Sjunnesson Johan, Rehncrona Stig
Department of Neurosurgery, University Hospital, Lund, Sweden.
Neurosurgery. 2007 Feb;60(2):327-32; discussion 332. doi: 10.1227/01.NEU.0000249273.41569.6E.
To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt surgery.
Seventy-five patients (mean age, 72.5 6 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 6 4.6 mo) and long-term (5.5 6 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index.
At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P < 0.05) in improved patients.
Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.
评估分流手术后6个月和5年时疑似正常压力脑积水患者的预后情况。
纳入75例有正常压力脑积水症状的患者（平均年龄72.5±9岁）。54例腰穿灌注试验和/或脑脊液穿刺试验结果为阳性的患者接受了脑脊液分流术，而21例试验结果为阴性的患者未接受手术。步行、反应时间、记忆力和图形匹配试验用作基线（手术前）检查，并在短期（6.1±4.6个月）和长期（5.5±1.4年）随访评估时重复进行。使用巴氏指数评估日常生活功能活动。
在6个月的随访检查中，83%的手术患者步态改善，65%反应时间改善，46%记忆力改善，31%图形匹配试验改善；96%的患者主观感觉有所改善。由于无关的死亡率（37%）以及合并症导致的总体健康状况下降，仅有27例患者可进行5年的随访评估。其中23例患者接受了分流治疗，步态和反应时间仍有近40%的改善，而认知测试改善的患者不到10%。与术前结果相比，56%的患者报告有主观改善。年龄小于75岁的患者改善更多（64%）；年龄大于75岁的患者中，只有11%的患者有所改善。改善患者的巴氏指数更高（P<0.05）。
正常压力脑积水患者从分流手术中获益至少5年。高死亡率、合并症和高龄阻碍了良好的长期预后，并强调了患者选择的重要性。
