Lalou Afroditi Despina, Czosnyka Marek, Placek Michal M, Smielewski Peter, Nabbanja Eva, Czosnyka Zofia
Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK.
Institute of Electronic Systems, Faculty of Electronics and Information Sciences, Warsaw University of Technology, 00-661 Warsaw, Poland.
J Clin Med. 2021 Apr 15;10(8):1711. doi: 10.3390/jcm10081711.
Despite the quantitative information derived from testing of the CSF circulation, there is still no consensus on what the best approach could be in defining criteria for shunting and predicting response to CSF diversion in normal pressure hydrocephalus (NPH).
We aimed to review the lessons learned from assessment of CSF dynamics in our center and summarize our findings to date. We have focused on reporting the objective perspective of CSF dynamics testing, without further inferences to individual patient management.
No single parameter from the CSF infusion study has so far been able to serve as an unquestionable outcome predictor. Resistance to CSF outflow (Rout) is an important biological marker of CSF circulation. It should not, however, be used as a single predictor for improvement after shunting. Testing of CSF dynamics provides information on hydrodynamic properties of the cerebrospinal compartment: the system which is being modified by a shunt. Our experience of nearly 30 years of studying CSF dynamics in patients requiring shunting and/or shunt revision, combined with all the recent progress made in producing evidence on the clinical utility of CSF dynamics, has led to reconsidering the relationship between CSF circulation testing and clinical improvement.
Despite many open questions and limitations, testing of CSF dynamics provides unique perspectives for the clinician. We have found value in understanding shunt function and potentially shunt response through shunt testing in vivo. In the absence of infusion tests, further methods that provide a clear description of the pre and post-shunting CSF circulation, and potentially cerebral blood flow, should be developed and adapted to the bed-space.
尽管通过脑脊液循环测试可获得定量信息，但在确定正常压力脑积水（NPH）分流标准及预测脑脊液分流反应的最佳方法上仍未达成共识。
我们旨在回顾本中心在脑脊液动力学评估中吸取的经验教训，并总结迄今为止的研究结果。我们专注于报告脑脊液动力学测试的客观观点，而不进一步推断个体患者的管理情况。
迄今为止，脑脊液输注研究中的单一参数都无法作为无可争议的结果预测指标。脑脊液流出阻力（Rout）是脑脊液循环的重要生物学标志物。然而，它不应被用作分流后改善情况的单一预测指标。脑脊液动力学测试提供了关于脑脊髓腔室流体动力学特性的信息：该系统正通过分流进行改变。我们在近30年中对需要分流和/或分流修正的患者进行脑脊液动力学研究的经验，结合近期在脑脊液动力学临床应用证据方面取得的所有进展，促使我们重新思考脑脊液循环测试与临床改善之间的关系。
尽管存在许多未解决的问题和局限性，但脑脊液动力学测试为临床医生提供了独特的视角。我们发现通过体内分流测试了解分流功能及潜在的分流反应具有价值。在缺乏输注测试的情况下，应开发并适用于临床环境的进一步方法，以清晰描述分流前后的脑脊液循环以及潜在的脑血流情况。
