Chang Tze-Wei, Tseng Pao-Hui, Wang Yi-Cheng, Tseng Guo-Fang, Chiu Tsung-Lang, Lin Shinn-Zong, Tsai Sheng-Tzung
Department of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, Taiwan.
Institiute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan.
J Clin Med. 2020 Apr 11;9(4):1084. doi: 10.3390/jcm9041084.
The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with Tc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) ( < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score ( < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score ( = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology.
特发性正常压力脑积水（iNPH）的诊断以及腰大池腹腔分流术治疗的结果仍有待系统探索。在此，我们旨在评估多巴胺能神经变性和白质小血管疾病的严重程度是否可作为接受腰大池腹腔分流术治疗的iNPH患者预后的预测指标。这是一项单中心回顾性研究，纳入了2016年6月至2018年3月在花莲慈济医院接受可编程式外科腰大池腹腔分流术的39例疑似iNPH患者。对所有患者，通过Tc-TRODAT-1 SPECT扫描确定多巴胺能神经变性情况，同时用脑部MRI评估白质小血管疾病（Fazekas分级）。所有患者均有术前和术后（6个月随访）的iNPH分级量表（iNPHGS）评分及卡氏功能状态评分（KPS）。采用线性回归分析多巴胺能神经变性和小血管疾病的严重程度与腰大池腹腔分流术治疗结果之间的相关性。术后患者的iNPHGS评分显著改善（术前为7.8±2.6；术后为5.7±2.6（改善26.9%）（<0.05））。此外，术后KPS也显著改善，较基线评分平均提高24.6%（<0.05）。观察到多巴胺能神经变性的严重程度与iNPHGS评分改善较差之间存在显著相关性（=0.03）。然而，iNPHGS评分的改善与白质小血管疾病无关。多巴胺能神经变性合并症抵消了术后的改善程度。虽然白质小血管疾病与iNPH发病率相关，但它可能不是分流手术的预后因素。这些发现对多巴胺能成像的应用具有启示意义，因为它们可能有助于预测iNPH患者的手术结果，而血管机制似乎参与了iNPH的病理生理学过程。
