Nocuń Anna, Mosiewicz Anna, Kaczmarczyk Robert, Kazalska Teresa, Czekajska-Chehab Elżbieta, Chrapko Beata, Trojanowski Tomasz
Department of Nuclear Medicine, Medical University of Lublin, Poland.
Nucl Med Rev Cent East Eur. 2015;18(2):84-8. doi: 10.5603/NMR.2015.0020.
Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-existing abnormalities. The most popular treatment option is surgical implantation of a shunt. Brain perfusion increase occurring months or years after successful shunt surgery is well described in the literature. Early improvement of perfusion is not well documented. Therefore, the objective of the present study was to determine patterns of brain perfusion changes 3-6 days after the ventriculoperitoneal shunting in patients with iNPH by using 99mTc-HMPAO SPECT.
Sixteen patients with iNPH (9 women, 7 men, mean age 64.1 ± 12.7 years) who underwent ventriculoperitoneal shunt surgery were included into the study group. Indications for implanting a shunt were based on clinical history, neuroimaging and CSF dynamic studies with an infusion test. Brain perfusion SPECT was performed 1-2 days before and 3-6 days after the surgical treatment. For comparison of perfusion before and after the surgery SPECT scans were assessed visually and semiquantitatively with voxel based analysis.
No side effects were observed after the surgery. Brain perfusion improvement after shunting was observed in 10 patients (62.5%). Patterns of perfusion changes varied between patients, with combinations of different bilateral and lateralized brain regions involved. Perfusion increased in the whole brain (3 patients), in the right cerebral hemisphere (1 patient) or in the separate cerebral regions (6 patients): frontal, parietal, temporal, cerebellum, cingulate gyrus. Perfusion improvement was predominantly observed in the frontal lobes: right frontal (3 cases, 18.8%), left frontal (3 cases, 18.8%).
Cerebral perfusion is recovered promptly after ventriculoperitoneal shunt surgery in about 60% of patients with iNPH. This improvement may be global or regional in different cerebral areas with prevalence of the frontal lobes.
特发性正常压力脑积水（iNPH）是一种临床综合征，由步态障碍、精神衰退和尿失禁三联征组成，伴有正常脑脊液压力（CSF），且无既往异常。最常用的治疗方法是手术植入分流器。文献中对成功分流手术后数月或数年出现的脑灌注增加有详细描述。早期灌注改善情况记录较少。因此，本研究的目的是通过使用99mTc-HMPAO SPECT确定iNPH患者脑室腹腔分流术后3 - 6天脑灌注变化模式。
16例接受脑室腹腔分流手术的iNPH患者（9例女性，7例男性，平均年龄64.1±12.7岁）纳入研究组。植入分流器的指征基于临床病史、神经影像学和脑脊液动力学研究及灌注试验。在手术治疗前1 - 2天和术后3 - 6天进行脑灌注SPECT检查。为比较手术前后的灌注情况，对SPECT扫描进行视觉和基于体素分析的半定量评估。
术后未观察到副作用。10例患者（62.5%）分流后脑灌注得到改善。不同患者的灌注变化模式各异，涉及不同的双侧和单侧脑区组合。全脑灌注增加（3例患者）、右侧大脑半球灌注增加（1例患者）或单独脑区灌注增加（6例患者）：额叶、顶叶、颞叶、小脑、扣带回。灌注改善主要见于额叶：右侧额叶（3例，18.8%）、左侧额叶（3例，18.8%）。
约60%的iNPH患者脑室腹腔分流术后脑灌注迅速恢复。这种改善可能是全脑性的或不同脑区局部性的，额叶最为常见。
