导水管脑脊液容积在特发性正常压力脑积水患者中增加，并在分流手术后减少。
Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery.
机构信息
From the Departments of Surgical Sciences and Radiology (J.S., M.F., E.-M.L.).
Lund University Bioimaging Center (K.M.B.), Lund University, Lund, Sweden.
出版信息
AJNR Am J Neuroradiol. 2019 Mar;40(3):453-459. doi: 10.3174/ajnr.A5972. Epub 2019 Feb 21.
BACKGROUND AND PURPOSE
Increased CSF stroke volume through the cerebral aqueduct has been proposed as a possible indicator of positive surgical outcome in patients with idiopathic normal pressure hydrocephalus; however, consensus is lacking. In this prospective study, we aimed to compare CSF flow parameters in patients with idiopathic normal pressure hydrocephalus with those in healthy controls and change after shunt surgery and to investigate whether any parameter could predict surgical outcome.
MATERIALS AND METHODS
Twenty-one patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched healthy controls were prospectively included and examined clinically and with MR imaging of the brain. Eighteen patients were treated with shunt implantation and were re-examined clinically and with MR imaging the day before the operation and 3 months postoperatively. All MR imaging scans included a phase-contrast sequence.
RESULTS
The median aqueductal CSF stroke volume was significantly larger in patients compared with healthy controls (103.5 μL; interquartile range, 69.8-142.8 μL) compared with 62.5 μL (interquartile range, 58.3-73.8 μL; < .01) and was significantly reduced 3 months after shunt surgery from 94.8 μL (interquartile range, 81-241 μL) to 88 μL (interquartile range, 51.8-173.3 μL; < .05). Net flow in the caudocranial direction (retrograde) was present in 11/21 patients and in 10/21 controls. Peak flow and net flow did not differ between patients and controls. There were no correlations between any CSF flow parameters and surgical outcomes.
CONCLUSIONS
Aqueductal CSF stroke volume was increased in patients with idiopathic normal pressure hydrocephalus and decreased after shunt surgery, whereas retrograde aqueductal net flow did not seem to be specific for patients with idiopathic normal pressure hydrocephalus. On the basis of the results, the usefulness of CSF flow parameters to predict outcome after shunt surgery seem to be limited.
背景与目的
通过脑导水管增加 CSF 容积已被提出作为特发性正常压力脑积水患者手术结果阳性的一个可能指标；然而，目前尚无共识。在这项前瞻性研究中，我们旨在比较特发性正常压力脑积水患者与健康对照者的 CSF 流参数，并比较分流术后的变化，以及探讨任何参数是否可以预测手术结果。
材料与方法
21 例特发性正常压力脑积水患者和 21 例年龄和性别匹配的健康对照者被前瞻性纳入并进行临床和脑部 MRI 检查。18 例患者接受分流植入术治疗，并在术前和术后 3 个月进行临床和 MRI 复查。所有 MRI 扫描均包括相位对比序列。
结果
与健康对照组（62.5 μL；四分位距，58.3-73.8 μL）相比，患者的脑导水管 CSF 搏动容积中位数明显更大（103.5 μL；四分位距，69.8-142.8 μL；<0.01），并且在分流术后 3 个月时从 94.8 μL（四分位距，81-241 μL）明显减少到 88 μL（四分位距，51.8-173.3 μL；<0.05）。21 例患者中有 11 例和 21 例对照组中均存在顺行颅尾方向（逆行）的净流。峰值流和净流在患者和对照组之间无差异。任何 CSF 流参数与手术结果之间均无相关性。
结论
特发性正常压力脑积水患者的脑导水管 CSF 搏动容积增加，分流术后减少，而脑导水管的逆行净流似乎不是特发性正常压力脑积水患者所特有的。基于这些结果，CSF 流参数预测分流术后结果的有用性似乎是有限的。
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