Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Acta Neurochir Suppl. 2021;131:355-358. doi: 10.1007/978-3-030-59436-7_68.
Tools available for diagnosis of normal pressure hydrocephalus (NPH) and prediction of shunt-response are overnight ICP monitoring, infusion studies, and extended lumbar drainage (ELD). We investigated the shunt-response predictive value by infusion tests versus ELD.
We retrospectively recruited 83 patients who had undergone both infusion study and ELD assessments and compared infusion study hydrodynamics with improvement at clinic follow-up after ELD and after shunting.
62 patients had Rout >11 mmHg/mL/min. 28 Showed physiotherapy-documented improvement following ELD, and were selected for shunting, of which 21 were shunted. Of these, 19 showed improvement. Eight patients with Rout >20 mmHg/mL/min showed no response to ELD and were not shunted.There were 21 patients with Rout <11 mmHg/mL/min: five were shunted, showed improvement at follow-up, and had Rout >6 mmHg/mL/min. ICP amplitude did not differ at baseline or plateau between responders and non-responders.
ELD response and CSF dynamics differed remarkably. All patients with Rout <6 mmHg/mL/min showed no improvement with ELD, indicating that ELD and shunting might be contraindicated in these subjects. High Rout patients with no response to ELD could merit further consideration.
用于诊断正常压力脑积水（NPH）和预测分流反应的工具包括过夜颅内压监测、输注研究和延长腰椎引流（ELD）。我们研究了输注试验与 ELD 对分流反应的预测价值。
我们回顾性招募了 83 名同时接受输注研究和 ELD 评估的患者，并比较了 ELD 后和分流后临床随访时输注研究的流体动力学与改善情况。
62 名患者的 Rout >11mmHg/mL/min。28 名患者在 ELD 后接受物理治疗记录的改善，并选择进行分流，其中 21 名患者进行了分流。其中，19 名患者的症状得到改善。8 名 Rout >20mmHg/mL/min 的患者对 ELD 无反应，未进行分流。21 名患者的 Rout <11mmHg/mL/min：其中 5 名患者进行了分流，在随访时症状改善，且 Rout >6mmHg/mL/min。在基线或平台期，反应者和无反应者的 ICP 幅度没有差异。
ELD 反应和 CSF 动力学明显不同。所有 Rout <6mmHg/mL/min 的患者 ELD 无改善，表明 ELD 和分流可能不适合这些患者。对 ELD 无反应的高 Rout 患者可能需要进一步考虑。
