Sankey Eric W, Jusué-Torres Ignacio, Elder Benjamin D, Goodwin C Rory, Batra Sachin, Hoffberger Jamie, Lu Jennifer, Blitz Ari M, Rigamonti Daniele
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Phipps 126, Baltimore, MD, USA.
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Phipps 126, Baltimore, MD, USA.
J Clin Neurosci. 2015 Aug;22(8):1303-8. doi: 10.1016/j.jocn.2015.02.019. Epub 2015 May 12.
We evaluated if patients with idiopathic normal pressure hydrocephalus (iNPH) showed functional improvement after primary endoscopic third ventriculostomy (ETV). The efficacy of ETV for iNPH remains controversial. We retrospectively reviewed 10 consecutive patients treated between 2009 and 2011 with ETV for iNPH. Seven patients with a median age of 73 years (range: 60-80) who underwent a primary ETV for iNPH were included for analysis. Median follow-up was 39 months (range: 26-46). Post-ETV stoma and aqueductal and cisternal flows were confirmed via high resolution, gradient echo and phase contrast MRI. Post-ETV timed up and go (TUG) and Tinetti performance oriented mobility assessment scores were compared to pre- and post-lumbar puncture (LP) values. A second LP was performed if ETV failed to sustain the observed improvement after initial LP. Patients who demonstrated ETV failure were subsequently shunted. Compared to pre-LP TUG and Tinetti values of 14.00 seconds (range: 12.00-23.00) and 22 (range: 16-24), post-LP scores improved to 11.00 seconds (range: 8.64-15.00; p=0.06) and 25 (range: 24-28; p=0.02), respectively. ETV failed to sustain this improvement with slight worsening between pre-LP and post-ETV TUG and Tinetti scores. Improvement from pre-LP assessment was regained after shunting and at last follow-up with TUG and Tinetti scores of 12.97 seconds (range: 9.00-18.00; p=0.250) and 25 (range: 18-27; p=0.07), and 11.87 seconds (range: 8.27-18.50; p=0.152) and 23 (range: 18-26; p=0.382), respectively. Despite stoma patency, ETV failed to sustain functional improvement seen after LP, however, improvement was regained after subsequent shunting suggesting that shunt placement remains the preferred treatment for iNPH.
我们评估了特发性正常压力脑积水（iNPH）患者在初次内镜下第三脑室造瘘术（ETV）后是否出现功能改善。ETV治疗iNPH的疗效仍存在争议。我们回顾性分析了2009年至2011年间连续接受ETV治疗的10例iNPH患者。纳入分析的7例患者，年龄中位数为73岁（范围：60 - 80岁），均接受了针对iNPH的初次ETV。中位随访时间为39个月（范围：26 - 46个月）。通过高分辨率梯度回波和相位对比MRI确认ETV术后造瘘口以及导水管和脑池的血流情况。将ETV术后定时起立行走试验（TUG）和Tinetti以性能为导向的移动性评估得分与腰椎穿刺（LP）前后的值进行比较。如果ETV在初次LP后未能维持观察到的改善，则进行第二次LP。表现出ETV失败的患者随后接受分流术。与LP前TUG值14.00秒（范围：12.00 - 23.00）和Tinetti值22（范围：16 - 24）相比，LP后得分分别改善至11.00秒（范围：8.64 - 15.00；p = 0.06）和25（范围：24 - 28；p = 0.02）。ETV未能维持这种改善，LP前与ETV后TUG和Tinetti得分之间略有恶化。分流术后以及最后一次随访时，恢复了LP前评估的改善，TUG和Tinetti得分分别为12.97秒（范围：9.00 - 18.00；p = 0.250）和25（范围：18 - 27；p = 0.07），以及11.87秒（范围：8.27 - 18.50；p = 0.152）和23（范围：18 - 26；p = 0.382）。尽管造瘘口通畅，但ETV未能维持LP后观察到的功能改善，不过，随后分流术后恢复了改善，这表明分流术仍然是iNPH的首选治疗方法。
