Department of Neurosurgery, Koto Memorial Hospital.
Department of Neurosurgery, Saiseikai Shiga Hospital.
Neurol Med Chir (Tokyo). 2023 Sep 15;63(9):420-425. doi: 10.2176/jns-nmc.2022-0367. Epub 2023 Jul 10.
Since the publication of guidelines for managing idiopathic normal pressure hydrocephalus (iNPH) in 2004, an increasing number of patients with iNPH have been undergoing shunt surgery in Japan. However, shunt surgeries for iNPH can be challenging because the procedures are performed on elderly patients. General anesthesia-related risks, such as postoperative pneumonia or delirium, are higher in the elderly. To decrease these risks, we applied spinal anesthesia on a lumboperitoneal shunt (LPS). Herein, we analyzed our methods focusing on the postoperative outcomes. We retrospectively analyzed 79 patients who underwent LPS at our institution with more than one year of follow-up. The patients were divided into two groups based on the anesthetic approach, that is, 1) general anesthesia and 2) spinal anesthesia, and were examined in terms of postoperative complications, delirium, and postoperative hospital stay. In the general anesthesia group, two patients had respiratory complications after the surgery. The postoperative delirium score using the intensive care delirium screening checklist (ICDSC) was 0 (2) (median [interquartile range]), and the length of postoperative hospital stay was 11 (4) days. In the spinal anesthesia group, no patients had respiratory complications. The postoperative mean ICDSC was 0 (1), and the length of postoperative hospital stay was 10 (3) days. Although there was no significant difference regarding postoperative delirium existed, LPS under spinal anesthesia decreased respiratory complications and significantly shortened the postoperative hospital stay. LPS under spinal anesthesia could be an alternative to general anesthesia in elderly patients with iNPH and possibly lessen the general anesthesia-related risks.
自 2004 年发表特发性正常压力脑积水（iNPH）管理指南以来，日本接受分流手术的 iNPH 患者数量逐渐增加。然而，iNPH 的分流手术具有挑战性，因为手术对象是老年患者。与全身麻醉相关的风险，如术后肺炎或谵妄，在老年人中更高。为了降低这些风险，我们对腰腹腔分流术（LPS）应用了脊髓麻醉。在此，我们分析了我们的方法，重点是术后结果。我们回顾性分析了在我院接受 LPS 治疗且随访时间超过 1 年的 79 例患者。根据麻醉方法将患者分为两组，即 1）全身麻醉和 2）脊髓麻醉，并从术后并发症、谵妄和术后住院时间方面进行检查。在全身麻醉组中，有 2 例患者在手术后出现呼吸并发症。使用重症监护谵妄筛查检查表（ICDSC）的术后谵妄评分分别为 0（2）（中位数[四分位数间距]），术后住院时间为 11（4）天。在脊髓麻醉组中，无患者出现呼吸并发症。术后平均 ICDSC 为 0（1），术后住院时间为 10（3）天。尽管术后谵妄方面无显著差异，但脊髓麻醉下的 LPS 减少了呼吸并发症，并显著缩短了术后住院时间。脊髓麻醉下的 LPS 可作为老年 iNPH 患者全身麻醉的替代方法，并可能降低与全身麻醉相关的风险。
