Chari Aswin, Dasgupta Debayan, Smedley Alexander, Craven Claudia, Dyson Edward, Matloob Samir, Thompson Simon, Thorne Lewis, Toma Ahmed K, Watkins Laurence
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
Acta Neurochir (Wien). 2017 Oct;159(10):1967-1978. doi: 10.1007/s00701-017-3281-2. Epub 2017 Aug 10.
Elective intraparenchymal intracranial pressure (ICP) monitoring is useful for the diagnosis and treatment of hydrocephalus and cerebrospinal fluid (CSF) disorders. This retrospective study analyzes median ICP and pulse amplitude (PA) recordings in neurosurgically naïve patients undergoing elective ICP monitoring for suspected CSF disorders.
Retrospective review of prospectively collated database of neurosurgically naïve patients undergoing elective ICP monitoring for suspected hydrocephalus and CSF disorders. Following extraction of the median ICP and PA values (separated into all, day and night time recordings), principal component analysis (PCA) was performed to identify the principal factors determining the spread of the data. Exploratory comparisons and correlations of ICP and PA values were explored, including by post hoc diagnostic groupings and age.
A total of 198 patients were identified in six distinct diagnostic groups (n = 21-47 in each). The PCA suggested that there were two main factors accounting for the spread in the data, with 61.4% of the variance determined largely by the PA and 33.0% by the ICP recordings. Exploratory comparisons of PA and ICP between the diagnostic groups showed significant differences between the groups. Specifically, significant differences were observed in PA between a group managed conservatively and the Chiari/syrinx, IIH, and NPH/LOVA groups and in the ICP between the conservatively managed group and high-pressure, IIH, and low-pressure groups. Correlations between ICP and PA revealed some interesting trends in the different diagnostic groups and correlations between ICP, PA, and age revealed a decreasing ICP and increasing PA with age.
This study provides insights into hydrodynamic disturbances in different diagnostic groups of patients with CSF hydrodynamic disorders. It highlights the utility of analyzing both median PA and ICP recordings, stratified into day and night time recordings.
选择性脑实质内颅内压（ICP）监测对于脑积水和脑脊液（CSF）疾病的诊断和治疗很有用。这项回顾性研究分析了因疑似CSF疾病而接受选择性ICP监测的未接受过神经外科手术患者的ICP中位数和脉搏振幅（PA）记录。
回顾性分析前瞻性整理的数据库，该数据库包含因疑似脑积水和CSF疾病而接受选择性ICP监测的未接受过神经外科手术患者。提取ICP和PA值的中位数（分为全部、白天和夜间记录）后，进行主成分分析（PCA）以确定决定数据分布的主要因素。探索性比较和分析ICP与PA值之间的相关性，包括通过事后诊断分组和年龄进行分析。
共识别出198例患者，分为六个不同的诊断组（每组n = 21 - 47）。主成分分析表明，有两个主要因素导致数据分布，其中61.4%的方差主要由PA决定，33.0%由ICP记录决定。各诊断组之间PA和ICP的探索性比较显示组间存在显著差异。具体而言，保守治疗组与Chiari/脊髓空洞症、IIH和NPH/LOVA组之间的PA存在显著差异，保守治疗组与高压、IIH和低压组之间的ICP存在显著差异。ICP与PA之间的相关性在不同诊断组中显示出一些有趣的趋势，ICP、PA与年龄之间的相关性显示随着年龄增长ICP降低而PA升高。
本研究深入了解了CSF流体动力学疾病不同诊断组中的流体动力学紊乱情况。它强调了分析PA和ICP中位数记录（分为白天和夜间记录）的实用性。
