Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Acta Neurochir Suppl. 2023;135:219-222. doi: 10.1007/978-3-031-36084-8_34.
Idiopathic normal pressure hydrocephalus (iNPH) is an often-overlooked or misdiagnosed brain disorder characterized by overt ventriculomegaly and associated with gait disturbances, cognitive impairment, and urinary incontinence. If correctly diagnosed, it is considered the only form of dementia treatable with surgery, namely through a ventriculoperitoneal or ventriculoatrial shunt with programmable valves.Among the 856 spinal and ventricular infusion tests performed from 2001 to 2017 at our institution, we analyzed 106 cases selected for suspected normotensive hydrocephalus. In all cases, Intracranial Elastance Index (IEI) and outflow resistance (Rout) values were calculated: 52 of these patients underwent Spinal Katzman Test (SKT), and the remaining 54 underwent an intraventricular infusion test (IVKT). Of the 40 patients in the SKT group with pathological elastance (71%), 17 also had a Rout >12 mmHg and 23 a Rout <12 mmHg. Of the 50 patients in the IVKT group with pathological elastance (92%), 38 also had a Rout >12 mmHg and 12 a Rout <12 mmHg.IVKT and SKT to date represent two useful tools in the diagnosis of normal pressure hydrocephalus. Despite being more invasive, IVKT, including both the intracranial elastance index (IEI) and Rout analysis, could be considered more reliable than SKT and therefore could be reserved for the most controversial cases.
特发性正常压力脑积水（iNPH）是一种常被忽视或误诊的脑部疾病，其特征为明显的脑室扩大，并伴有步态障碍、认知障碍和尿失禁。如果正确诊断，它被认为是唯一可通过手术治疗的痴呆症形式，即通过可调压脑室-腹腔或脑室-心房分流术。在我们机构 2001 年至 2017 年间进行的 856 例脊髓和脑室输注试验中，我们分析了 106 例疑似正常压力性脑积水的选定病例。在所有病例中，均计算了颅内弹性指数（IEI）和流出阻力（Rout）值：其中 52 例患者进行了脊髓 Katzman 试验（SKT），其余 54 例患者进行了脑室内输注试验（IVKT）。在 SKT 组中，40 例具有病理性弹性的患者（71%）中，有 17 例 Rout >12mmHg，23 例 Rout <12mmHg。在 IVKT 组中，50 例具有病理性弹性的患者（92%）中，有 38 例 Rout >12mmHg，12 例 Rout <12mmHg。迄今为止，IVKT 和 SKT 是诊断正常压力性脑积水的两种有用工具。尽管 IVKT 更具侵入性，但包括颅内弹性指数（IEI）和 Rout 分析在内的 IVKT 可能比 SKT 更可靠，因此可以保留用于最具争议的病例。
