脉压幅度、达到平台期的时间以及在腰椎灌注试验中获得的斜率对特发性正常压力脑积水研究的预后价值。

Prognostic value of the pulse pressure amplitudes, time to reach the plateau and the slope obtained in the lumbar infusion test for the study of idiophatic normal pressure hydrocephalus.

作者信息

Otero Rodríguez Álvaro, Arandia Guzmán Daniel Ángel, García Martín Andoni, Torres Carretero Luis, Garrido Ruiz Alejandra, Sousa Casasnovas Pablo, Roa Montes de Oca Juan Carlos

机构信息

Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España.

出版信息

Neurocirugia (Engl Ed). 2021 Apr 16. doi: 10.1016/j.neucir.2021.02.004.

DOI:10.1016/j.neucir.2021.02.004

PMID:33875381

Abstract

BACKGROUND AND OBJECTIVE

To study the prognostic value of the resistance to the cerebrospinal fluid outflow (Rout) obtained in the lumbar infusion test in idiopathic normal pressure hydrocephalus (iNPH), as well as the pulse pressure amplitudes in the different periods of the test and other new variables extracted by Neuropicture® software.

MATERIAL AND METHODS

Patients with ́probable iNPH́ who underwent a lumbar infusion test were retrospectively revised. The positive predictive values (PPV) of the cutoff point of the best prognostic accuracy of the Rout, the basal pulse pressure amplitude (AMP0), the pulse pressure amplitude during the first 10minutes (AMP), the plateau pulse pressure amplitude (AMPmes), the Rout pulse pressure amplitude (AMP), the time to reach the plateau (T), and the slope until reaching the plateau were determined. Patients were categorized either as responders or non-responders.

RESULTS

The study included 64 responders patients and 16 non-responders patients. The PPV of Rout> 15mmHg/ml/min was 91.7%; AMP0> 2.34mmHg: 91.3%; AMP10min>4.34mmHg: 83.3%; AMPmes>12.44mmHg: 84.6%; AMP>6.34mmHg: 85%; T <634seconds: 86.7%; P>0.040mmHg/sec: 96.3%.

CONCLUSIONS

Rout is a valid criterion to indicate a ventricular shunt. Pulse pressure amplitudes in the different periods of the lumbar infusion test, in addition to T and P, are other variables whose positivity is indicative of shunt response and should be considered in the diagnostic protocol of the iNPH.

摘要

背景与目的

研究腰椎穿刺灌注试验中获得的脑脊液流出阻力（Rout）对特发性正常压力脑积水（iNPH）的预后价值，以及试验不同阶段的脉压幅度和Neuropicture®软件提取的其他新变量。

材料与方法

对接受腰椎穿刺灌注试验的“疑似iNPH”患者进行回顾性分析。确定Rout、基础脉压幅度（AMP0）、最初10分钟的脉压幅度（AMP）、平台期脉压幅度（AMPmes）、Rout脉压幅度（AMP）、达到平台期的时间（T）以及达到平台期的斜率等最佳预后准确性切点的阳性预测值（PPV）。将患者分为反应者和无反应者。

结果

该研究纳入了64例反应者和16例无反应者。Rout>15mmHg/ml/min的PPV为91.7%；AMP0>2.34mmHg：91.3%；AMP10min>4.34mmHg：83.3%；AMPmes>12.44mmHg：84.6%；AMP>6.34mmHg：85%；T<634秒：86.7%；P>0.040mmHg/秒：96.3%。