Yang Jun, Dombrowski Stephen M, Krishnan Chandra, Krajcir Natalie, Deshpande Abhishek, El-Khoury Serge, Guruprakash Deepti Kamasamudram, Luciano Mark G
Department of Neurological Surgery, Section of Pediatric and Congenital Neurological Surgery, CSF Physiology Laboratory, Neurological Institute, Cleveland Clinic, S-60, 9500 Euclid Avenue, Cleveland 44195, USA.
Clin Neurol Neurosurg. 2013 Sep;115(9):1729-34. doi: 10.1016/j.clineuro.2013.03.017. Epub 2013 Apr 29.
The aim of this study was to examine lumbar CSF-VEGF levels from elderly patients with ventriculomegaly to evaluate the possible circadian or periodic concentration profile and relevance to the prediction of drainage response.
Lumbar CSF samples were collected in 1-h interval over 35 h from 22 patients with ventriculomegaly. CSF-VEGF levels were measured to elucidate the possible circadian or periodic concentration profiles. These VEGF levels were evaluated for correlations with clinical response to CSF drainage, ventricle size and other clinical information.
The 35-h CSF-VEGF levels demonstrated a periodic concentration pattern with significant episodic fluctuation with 3-5h intervals. CSF-VEGF levels in non-responder group in which patients did not show clinical improvement with CSF drainage were significantly higher than these in responder group.
VEGF variation in hydrocephalus patients suggests its possible pathophysiological role in hydrocephalus. The periodic concentration pattern of CSF-VEGF must be considered when choosing the most appropriate time for sample collection or clinical manipulation. Increased VEGF level in patients who showed no improvement with CSF drainage suggests that a possible greater ischemic or vascular injury may play a role in these patients. Pending further studies, these results suggest that high VEGF levels have a potential application in predicting non-responder patients with CSF drainage and so reducing the morbidity and cost of drainage and shunting in these patients.
本研究旨在检测脑室扩大老年患者的腰椎脑脊液血管内皮生长因子（CSF-VEGF）水平，以评估其可能的昼夜或周期性浓度变化情况以及与引流反应预测的相关性。
对22例脑室扩大患者在35小时内每隔1小时采集腰椎脑脊液样本。检测CSF-VEGF水平以阐明可能的昼夜或周期性浓度变化情况。评估这些VEGF水平与脑脊液引流临床反应、脑室大小及其他临床信息的相关性。
35小时的CSF-VEGF水平呈现出周期性浓度模式，有显著的间歇性波动，间隔为3 - 5小时。脑脊液引流后未显示临床改善的无反应组患者的CSF-VEGF水平显著高于有反应组。
脑积水患者VEGF的变化提示其在脑积水发病机制中可能发挥病理生理作用。在选择最合适的样本采集时间或临床操作时间时，必须考虑CSF-VEGF的周期性浓度模式。脑脊液引流无改善患者的VEGF水平升高表明，可能更大程度的缺血或血管损伤在这些患者中起作用。在进一步研究之前，这些结果表明高VEGF水平在预测脑脊液引流无反应患者方面具有潜在应用价值，从而降低这些患者的引流和分流发病率及成本。
