Department of Neurology, Tokyo Kyosai Hospital, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Clin Neurol Neurosurg. 2022 Nov;222:107425. doi: 10.1016/j.clineuro.2022.107425. Epub 2022 Aug 28.
We aimed to evaluate a possible association between preoperative factors (disease duration and vascular risk factors) and shunt responsiveness in patients with idiopathic normal-pressure hydrocephalus (iNPH).
We conducted a retrospective observational study in a high-volume center for iNPH treatment in Japan and reviewed the clinical data of 107 consecutive patients with probable iNPH who underwent shunt surgery between January 1, 2018, and August 31, 2019, and were followed up for at least 12 months after surgery. Preoperatively, these patients underwent the timed up-and-go test (TUG) and Mini-Mental State Examination (MMSE); moreover, follow-up evaluations were performed 12 months postoperatively, at which TUG and MMSE scores were used as metrics for shunt responsiveness assessment. The degree of shunt responsiveness was regressed to several preoperative factors, including preoperative TUG and MMSE scores, vascular risk factors, and duration from iNPH onset to shunt surgery, to evaluate which preoperative factors may be predictive of shunt responsiveness.
In multivariate regression analysis, there was no statistically significant association between the presence of preoperative vascular risk factors and the postoperative TUG or MMSE score 12 months after shunt surgery. Meanwhile, preoperative history of ischemic stroke and a longer duration from iNPH onset to surgery were significantly associated with poorer shunt responsiveness in terms of MMSE and TUG scores.
The current study suggested the potential involvement of stroke history and disease duration with the 1-year prognosis of iNPH after shunt surgery, of which validity needs to be corroborated in further studies.
评估特发性正常压力脑积水（iNPH）患者术前因素（疾病持续时间和血管危险因素）与分流反应之间的可能关联。
我们在日本一家 iNPH 治疗的大容量中心进行了一项回顾性观察性研究，回顾了 2018 年 1 月 1 日至 2019 年 8 月 31 日期间接受分流手术的 107 例疑似 iNPH 连续患者的临床资料，这些患者在手术后至少随访 12 个月。术前，这些患者进行了计时起立行走测试（TUG）和简易精神状态检查（MMSE）；此外，术后 12 个月进行了随访评估，使用 TUG 和 MMSE 评分作为分流反应评估的指标。将分流反应的程度回归到几个术前因素，包括术前 TUG 和 MMSE 评分、血管危险因素以及从 iNPH 发病到分流手术的时间，以评估哪些术前因素可能预测分流反应。
在多变量回归分析中，术前血管危险因素的存在与分流手术后 12 个月的术后 TUG 或 MMSE 评分之间没有统计学显著关联。同时，术前缺血性卒中史和从 iNPH 发病到手术的时间较长与 MMSE 和 TUG 评分的分流反应较差显著相关。
本研究提示卒中病史和疾病持续时间可能与分流手术后 iNPH 的 1 年预后有关，其有效性需要进一步研究证实。
