Lalou Afroditi-Despina, McTaggart James S, Czosnyka Zofia H, Garnett Matthew R, Krishnakumar Deepa, Czosnyka Marek
Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Hills Road, Cambridge, CB20QQ, UK.
Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospital, Cambridge, UK.
Childs Nerv Syst. 2020 Jan;36(1):73-86. doi: 10.1007/s00381-019-04263-4. Epub 2019 Jul 19.
There is a growing body of evidence highlighting the importance of comprehensive intracranial pressure (ICP) values in pseudotumor cerebri syndrome (PTCS). Due to the highly dynamic nature of ICP, several methods of ICP monitoring have been established, including the CSF infusion study. We have performed a retrospective review of the CSF dynamics measurements for all pediatric patients investigated for PTCS in our center and examined their diagnostic value compared with clinical classification.
We retrospectively recruited 31 patients under 16 years of age investigated for PTCS by CSF infusion test. We used the clinically provided Friedman classification 13/31 patients with definite PTCS (group A), 13/31 with probable PTCS (group B), and 5/31 not PTCS (group C), to compare CSF dynamics in the 3 groups.
CSF pressure (CSFp) was significantly increased in group A (29.18 ± 7.72 mmHg) compared with B (15.31 ± 3.47 mmHg; p = 1.644e-05) and C (17.51 ± 5.87; p = 0.01368). The amplitude (AMP) was higher in the definite (2.18 ± 2.06 mmHg) than in group B (0.68 ± 0.37; p = 0.01382). There was no in either CSFp or AMP between groups B and C. No lower breakpoint of the AMP-P line was observed in group A but was present in 2/13 and 2/5 patients in groups B and C. In group A, sagittal sinus pressure (SSp) and elasticity were the only parameters above threshold (p = 4.2e-06 and p = 0.001953, respectively), In group B, only the elasticity was significantly higher than the threshold (p = 004257). Group C did not have any of the parameters raised. The AUC of CSFp, elasticity, and SSp for the 3 groups was 93.8% (84.8-100% CI).
Monitoring of CSFp and its dynamics, besides providing a more precise methodology for measuring CSFp, could yield information on the dynamic parameters of CSFp that cannot be derived from CSFp as a number, accurately differentiating between the clinically and radiologically derived entities of PTCS.
越来越多的证据表明，在假性脑瘤综合征（PTCS）中，全面的颅内压（ICP）值具有重要意义。由于ICP具有高度动态性，已建立了多种ICP监测方法，包括脑脊液输注研究。我们对本中心所有因PTCS接受检查的儿科患者的脑脊液动力学测量进行了回顾性分析，并与临床分类进行比较，以检验其诊断价值。
我们回顾性纳入了31例16岁以下因PTCS接受脑脊液输注试验检查的患者。我们采用临床提供的Friedman分类，将31例患者分为明确的PTCS组（A组，13例）、可能的PTCS组（B组，13例）和非PTCS组（C组，5例），比较三组的脑脊液动力学情况。
与B组（15.31±3.47 mmHg；p = 1.644e-05）和C组（17.51±5.87；p = 0.01368）相比，A组的脑脊液压力（CSFp）显著升高（29.18±7.72 mmHg）。明确诊断组的波幅（AMP）（2.18±2.06 mmHg）高于B组（0.68±0.37；p = 0.01382）。B组和C组之间的CSFp或AMP均无差异。A组未观察到AMP-P线的下限断点，而B组和C组分别有2/13和2/5的患者出现。在A组中，矢状窦压力（SSp）和弹性是仅有的高于阈值的参数（分别为p = 4.2e-06和p = 0.001953），在B组中，只有弹性显著高于阈值（p = 004257）。C组没有任何参数升高。三组CSFp、弹性和SSp的曲线下面积（AUC）为93.8%（84.8 - 100%可信区间）。
监测CSFp及其动力学，除了能提供更精确的CSFp测量方法外，还能得出CSFp动态参数的信息，而这些信息无法从作为一个数值的CSFp中获得，从而能准确区分临床和影像学诊断的PTCS类型。
