Ramesh Vengalathur Ganesan, Narasimhan Vidhya, Balasubramanian Chandramouli
Department of Neurosurgery, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Tamil Nadu, India.
Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Asian J Neurosurg. 2017 Apr-Jun;12(2):153-158. doi: 10.4103/1793-5482.145110.
Communicating hydrocephalus often poses a challenge in diagnosis and management decisions.
The objective of this study is to measure the opening pressure (P), pressure volume index (PVI), and cerebrospinal fluid outflow resistance (R), in patients with communicating hydrocephalus using bolus lumbar injection method and to evaluate its diagnostic and prognostic value.
The study was conducted in 50 patients with communicating hydrocephalus, including normal pressure hydrocephalus (NPH) (19), post-meningitic hydrocephalus (23) and post-traumatic hydrocephalus (8). An improvised bolus lumbar injection method [the Madras Institute of Neurology (MIN) method] was used.
In the NPH Group, the CSF dynamics studies correlated well with the clinico-radiological classification. The prediction of shunt responsiveness by CSF dynamics studies correlated with good outcome in 87.5%. In the post-meningitic hydrocephalus group, the value of CSF dynamics studies in predicting patients needing shunt was 89.5%. The CSF dynamics studies detected patients who needed shunt earlier than clinical or radiological indications. In the post-traumatic hydrocephalus group, 62.5% of patients improved with the treatment based on CSF dynamics studies.
The improvised bolus lumbar injection method (MIN method) is a very simple test with fairly reliable and reproducible results. Study of CSF dynamics is a valuable tool in communicating hydrocephalus for confirmation of diagnosis and predicting shunt responsiveness. This is the first time that the value of CSF dynamics has been studied in patients with post-meningitic hydrocephalus. It was also useful for early selection of cases for shunting and for identifying patients with atrophic ventriculomegaly, thereby avoiding unnecessary shunt.
交通性脑积水在诊断和管理决策方面常常构成挑战。
本研究的目的是使用大剂量腰椎注射法测量交通性脑积水患者的初压（P）、压力容量指数（PVI）和脑脊液流出阻力（R），并评估其诊断和预后价值。
该研究对50例交通性脑积水患者进行，包括正常压力脑积水（NPH）患者19例、脑膜炎后脑积水患者23例和创伤后脑积水患者8例。采用了一种简易的大剂量腰椎注射法[马德拉斯神经病学研究所（MIN）法]。
在NPH组中，脑脊液动力学研究与临床放射学分类相关性良好。脑脊液动力学研究对分流反应性的预测与87.5%的良好预后相关。在脑膜炎后脑积水组中，脑脊液动力学研究在预测需要分流的患者方面的价值为89.5%。脑脊液动力学研究比临床或放射学指征更早地检测出需要分流的患者。在创伤后脑积水组中，基于脑脊液动力学研究，62.5%的患者治疗后病情改善。
简易大剂量腰椎注射法（MIN法）是一项非常简单的检查，结果相当可靠且可重复。脑脊液动力学研究是交通性脑积水诊断和预测分流反应性的宝贵工具。这是首次对脑膜炎后脑积水患者的脑脊液动力学价值进行研究。它对于早期选择分流病例和识别脑室扩大萎缩患者也很有用，从而避免不必要的分流。
