Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden.
Acta Neurochir (Wien). 2022 Feb;164(2):469-478. doi: 10.1007/s00701-021-05085-7. Epub 2021 Dec 30.
Idiopathic normal pressure hydrocephalus (iNPH) is a disease that comes with a great impact on the patient's life. The only treatment for iNPH, which is a progressive disease, is shunt surgery. It is previously indicated that early intervention might be of importance for the outcome.
To investigate if a longer waiting time for surgery, negatively influences the clinical outcome.
Eligible for this study were all iNPH patients (n = 3007) registered in the Swedish Hydrocephalus Quality Registry (SHQR) during 1 of January 2004-12 of June 2019. Waiting time, defined as time between the decision to accept a patient for surgery and shunt surgery, was divided into the intervals ≤ 3, 3.1-5.9 and ≥ 6 months. Clinical outcome was assessed 3 and 12 months after surgery using the modified iNPH scale, the Timed Up and Go (TUG) test and the mini mental state examination (MMSE).
Three months after surgery, 57% of the patients with ≤ 3 months waiting time showed an improvement in modified iNPH scale (≥ 5 points) whereas 52% and 46% of patients with 3.1-5.9 and ≥ 6 months waiting time respectively improved (p = 0.0115). At 12 months of follow-up, the corresponding numbers were 61%, 52% and 51% respectively (p = 0.0536).
This population-based study showed that in patients with iNPH, shunt surgery should be performed within 3 months of decision to surgery, to attain the best outcome.
特发性正常压力脑积水（iNPH）是一种对患者生活影响巨大的疾病。iNPH 是一种进行性疾病，唯一的治疗方法是分流手术。此前有研究表明，早期干预可能对结果很重要。
研究手术等待时间的延长是否会对临床结果产生负面影响。
本研究纳入了 2004 年 1 月 1 日至 2019 年 6 月 12 日期间在瑞典脑积水质量登记处（SHQR）登记的所有 iNPH 患者（n=3007）。将等待时间定义为决定接受手术到分流手术之间的时间，分为≤3、3.1-5.9 和≥6 个月三个时间段。术后 3 个月和 12 个月使用改良 iNPH 量表、计时起立行走测试（TUG）和简易精神状态检查（MMSE）评估临床结果。
术后 3 个月，等待时间≤3 个月的患者中有 57%在改良 iNPH 量表上（≥5 分）得到改善，而等待时间为 3.1-5.9 个月和≥6 个月的患者分别有 52%和 46%得到改善（p=0.0115）。在 12 个月的随访中，相应的数字分别为 61%、52%和 51%（p=0.0536）。
这项基于人群的研究表明，对于 iNPH 患者，应在决定手术后 3 个月内进行分流手术，以获得最佳效果。
