外伤性脑积水与萎缩性脑积水脑脊液动力学的差异，包括减压和颅骨成形术的影响。

Differences in Cerebrospinal Fluid Dynamics in Posttraumatic Hydrocephalus Versus Atrophy, Including Effect of Decompression and Cranioplasty.

机构信息

Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.

Department of Intensive Care, Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint Etienne, France.

出版信息

Acta Neurochir Suppl. 2021;131:343-347. doi: 10.1007/978-3-030-59436-7_66.

DOI:10.1007/978-3-030-59436-7_66

PMID:33839872

Abstract

INTRODUCTION

Challenges in diagnosing post-traumatic hydrocephalus (PTH) have created a need for an accurate diagnostic tool. We aim to report CSF dynamics in PTH and atrophy, along with differences before and after cranioplasty.

METHODS

We retrospectively analyzed traumatic brain injury patients with ventriculomegaly who had infusion studies. We divided patients depending on CSF dynamics into two groups: 'likely PTH' (A) and 'likely atrophy' (B). A group of idiopathic normal pressure hydrocephalus shunt-responsive patients was used for comparison (C).

RESULTS

Group A consisted of 36 patients who were non-decompressed or had a cranioplasty in situ for over 1 month. Group B included 16 patients with low Rout, AMP, and dAMP, 9 of whom were decompressed. Rout and dAMP were significantly higher in Group A than B, but significantly lower than Group C (45 iNPH patients). RAP change during infusion in group A indicated depleted compensatory reserve compared to ample reserve in group B. Repeat studies in five decompressed patients post-cranioplasty showed all parameters increased.

CONCLUSIONS

Infusion tests are not useful in decompressed patients, whilst cranioplasty allowed differentiation between possible PTH and atrophy. Rout and AMP were significantly lower in PTH compared to iNPH and did not always reflect the degree of hydrocephalus reported on imaging.

摘要

简介

诊断创伤后脑积水（PTH）的挑战催生了对准确诊断工具的需求。我们旨在报告 PTH 和萎缩时的 CSF 动力学，并比较颅骨成形术前、后的差异。

方法

我们回顾性分析了伴有脑室扩大的创伤性脑损伤患者的输注研究。我们根据 CSF 动力学将患者分为两组：“可能为 PTH”（A 组）和“可能为萎缩”（B 组）。我们还纳入了一组特发性正常压力脑积水（iNPH）有分流反应的患者作为对照（C 组）。

结果

A 组包括 36 例未减压或原位颅骨成形术超过 1 个月的患者。B 组包括 16 例 Rout、AMP 和 dAMP 值低的患者，其中 9 例接受了减压手术。与 B 组相比，A 组的 Rout 和 dAMP 值明显更高，但明显低于 C 组（45 例 iNPH 患者）。A 组在输注过程中 RAP 的变化表明其储备补偿耗尽，而 B 组则有充足的储备补偿。对 5 例减压术后再次进行研究的患者进行研究，结果显示所有参数均增加。