Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14(th) Terrace (D4-6), Miami, FL 33136, United States.
Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14(th) Terrace (D4-6), Miami, FL 33136, United States.
J Neurol Sci. 2018 Oct 15;393:105-109. doi: 10.1016/j.jns.2018.08.002. Epub 2018 Aug 6.
Normal pressure hydrocephalus (NPH) is generally treated with ventriculoperitoneal shunts (VPS), with improved symptoms in the majority of patients. We performed a retrospective chart review study in order to describe patterns of, and risk factors for, delayed symptom progression after initially successful VPS placement. 69 consecutive patients underwent VPS placement for NPH, and were followed for a minimum of 12 months postoperatively. 55 patients (80%) had objective improvement in their NPH symptoms after surgery. Of these, 27 patients (49%) developed delayed deterioration of at least one of their NPH symptoms, at a mean of 28.3 months postoperatively (range, 3-77). 1 of the 27 patients was found to have shunt malfunction; 19 had specific clinical or imaging evidence of shunt function. 6/19 patients had transient improvement in their symptoms (lasting 30 days or more) after adjustment of their programmable shunt valves (32%), although symptoms in all of these patients later worsened. During a mean follow up period of 44.4 months (range, 15-87), 12 patients (44%) received other neurological diagnoses felt to at least partially explain their symptoms. Increased patient age was associated with likelihood of delayed symptom progression. We conclude that delayed symptom progression is common after VPS placement for NPH, including after initial symptom improvement; that symptom progression can often be temporarily palliated by shunt valve pressure adjustment; and that older patients are more likely to experience delayed symptom progression. We suggest that patients and their families be counselled accordingly before surgery.
正常压力脑积水（NPH）通常采用脑室腹腔分流术（VPS）治疗，大多数患者的症状都有所改善。我们进行了一项回顾性图表审查研究，以描述最初成功进行 VPS 放置后症状进展延迟的模式和危险因素。69 例连续患者因 NPH 接受 VPS 放置，并在术后至少随访 12 个月。55 例患者（80%）的 NPH 症状在手术后有客观改善。其中，27 例患者（49%）至少有一种 NPH 症状出现延迟恶化，平均时间为术后 28.3 个月（范围为 3-77）。27 例患者中有 1 例发现分流器故障；19 例有特定的临床或影像学证据表明分流器功能正常。19 例患者中的 6 例（32%）在调整其可编程分流阀后症状短暂改善（持续 30 天或更长时间），尽管所有这些患者的症状后来都恶化了。在平均随访 44.4 个月（范围为 15-87）期间，12 例患者（44%）被诊断为其他神经系统疾病，这些疾病至少部分解释了他们的症状。患者年龄增加与症状进展延迟的可能性相关。我们的结论是，VPS 放置治疗 NPH 后，包括初始症状改善后，症状进展很常见；症状进展通常可以通过分流阀压力调整暂时缓解；年龄较大的患者更有可能出现症状进展延迟。我们建议在手术前相应地对患者及其家属进行咨询。
