Liu Ann, Sankey Eric W, Jusué-Torres Ignacio, Patel Mira A, Elder Benjamin D, Goodwin C Rory, Hoffberger Jamie, Lu Jennifer, Rigamonti Daniele
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Clin Neurol Neurosurg. 2016 Apr;143:34-8. doi: 10.1016/j.clineuro.2016.02.013. Epub 2016 Feb 9.
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting.
A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed.
58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n=39, 67%) and diabetes mellitus (n=11, 19%). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90%) had cognitive decline, and 43 (74%) had urinary incontinence. Forty-three (74%) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p<0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p=0.082), timed up-and-go (TUG) improved from 18 to 13s (p<0.0001), and Tinetti score improved from 19 to 25 (p<0.0001) after VA shunting. 78% of patients had improvement in at least one of their symptoms with 66% of patients having improvement in gait, 53% having improvement in their cognition, and 52% having improved urinary incontinence. A total of 21 patients (36%) had improvement in all 3 symptoms.
There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH.
特发性正常压力脑积水（iNPH）是一种神经疾病，典型表现为进行性步态障碍、尿失禁和认知功能减退三联征。治疗主要包括脑室腹腔（VP）分流术，但另一种选择是脑室心房（VA）分流术。本研究旨在描述和评估主要接受VA分流术治疗的iNPH患者的临床结局。
对2003年至2013年在单一机构接受VA分流术治疗的iNPH患者进行回顾性研究。
58例iNPH患者接受了初次VA分流术，中位年龄为74岁（四分位间距：70 - 80岁）。最常见的合并症包括高血压（n = 39，67%）和糖尿病（n = 11，19%）。VA分流术前症状的中位持续时间为24个月（四分位间距：12 - 36个月）。所有患者均有步态障碍，52例（90%）有认知功能下降，43例（74%）有尿失禁。43例（74%）患者具备所有三种症状。在中位末次随访16个月（四分位间距：7 - 26个月）时，iNPH中位评分从6分改善至3分（p < 0.0001），简易精神状态检查表（MMSE）评分有从26分增至29分的趋势（p = 0.082），计时起立行走测试（TUG）时间从18秒改善至13秒（p < 0.0001），Tinetti评分从19分改善至25分（p < 0.0001）。78%的患者至少有一种症状得到改善，其中66%的患者步态改善，53%的患者认知功能改善，52%的患者尿失禁改善。共有21例（36%）患者所有三种症状均得到改善。
通过iNPH评分、TUG和Tinetti评分评估，功能结局有显著改善，但MMSE评分的改善接近显著水平。患者的步态、尿功能和认知相关临床症状也有所改善。这些结果表明，对于iNPH，VA分流术可作为VP分流术有效的主要治疗替代方案选择。
