Department of Neurosurgery, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, México.
World Neurosurg. 2013 Feb;79(2):340-6. doi: 10.1016/j.wneu.2012.10.003. Epub 2012 Oct 5.
To propose a scoring system using endoscopy for assessment of the inflammatory alterations caused by neurocysticercosis (NCC) inside the ventricular cavities and the basal subarachnoid space.
Video recordings of the endoscopic procedures in patients with hydrocephalus secondary to NCC were assessed in a two-phase study. In the first phase (n = 10), the assigned score of each patient was correlated with the cerebrospinal fluid values obtained by lumbar and ventricular puncture. Reproducibility was determined using an intraclass correlation coefficient. In the second phase (n = 30), the prognostic value of the score was tested by comparing it with the patient's Karnofsky performance score (KPS) 3 months after endoscopy.
The score included four main components: ependymal findings, number of involved sites, abnormalities in the subarachnoid space, and other alterations. These values were summed to produce a total score, which correlated strongly with both protein and cell counts from ventricular cerebrospinal fluid. The intraclass correlation coefficient of the global score was 0.85. In the second phase, the scores were divided into mild, moderate, and severe categories (6, 15, and 9 patients). The initial KPS was similar between the groups (P = 0.56); however, when measured 3 months later, there were significant differences (P = 0.02). The logistic regression analysis of patients with a score in the severe range (odds ratio = 0.09; 95% confidence interval, 0.06-0.64) showed a reduced chance for achieving a good outcome (KPS ≥90) after 3 months.
Our scoring system enables endoscopic classification of the damage caused by NCC in the ventricular and basal subarachnoid space. The score has a biologic basis and a good internal reproducibility. The score seems to be useful for determining the short-term prognosis, and patients with high scores require additional therapeutic measures to improve their outcomes.
提出一种使用内镜评估脑囊尾蚴病（NCC）引起的脑室腔和基底蛛网膜下腔炎症改变的评分系统。
对继发于 NCC 脑积水的患者的内镜手术视频记录进行了两项研究评估。在第一阶段（n=10），将每位患者的评分与腰椎和脑室穿刺获得的脑脊液值相关联。使用组内相关系数确定可重复性。在第二阶段（n=30），通过比较评分与患者内镜检查后 3 个月的卡诺夫斯基表现评分（KPS）来测试评分的预后价值。
评分包括四个主要组成部分：室管膜发现、受累部位数量、蛛网膜下腔异常和其他改变。这些值相加得出总分，与脑室脑脊液中的蛋白和细胞计数密切相关。总体评分的组内相关系数为 0.85。在第二阶段，评分分为轻度、中度和重度（6、15 和 9 例患者）。各组的初始 KPS 相似（P=0.56）；然而，3 个月后测量时，存在显著差异（P=0.02）。严重程度评分患者的逻辑回归分析（比值比=0.09；95%置信区间，0.06-0.64）显示，3 个月后获得良好结局（KPS≥90）的机会降低。
我们的评分系统能够对内镜评估 NCC 在脑室和基底蛛网膜下腔引起的损伤进行分类。该评分具有生物学基础和良好的内部可重复性。评分似乎可用于确定短期预后，评分较高的患者需要额外的治疗措施以改善结局。
