Department of Neurosurgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Neurosurgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Clin Neurol Neurosurg. 2024 Jun;241:108295. doi: 10.1016/j.clineuro.2024.108295. Epub 2024 Apr 23.
Several radiological markers have been linked to clinical improvement after shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). However, iNPH has no pathognomonic feature, and patients are still diagnosed as probable, possible, or unlikely cases based on clinical symptoms, imaging findings, and invasive supplementary tests. The predictive value of the disproportionately enlarged subarachnoid space hydrocephalus (DESH) score is not yet conclusively determined, but it might offer a more accurate diagnostic method. The aim of the present retrospective cohort study was to validate the predictive power of the DESH score for clinical improvement after shunt surgery in iNPH patients.
We retrospectively obtained presurgical MRI and/or CT scans from 71 patients with iNPH who underwent ventriculoperitoneal shunt surgery. Radiological images were evaluated for Evans index (EI), corpus callosal angle (CA), tight high convexity (THC), Sylvian fissure dilation, and focal sulci dilation. These markers were aggregated to determine the DESH score. Patient journal entries were used to subjectively determine the extent of improvement in gait function, urinary incontinence, and/or cognition as a measure of shunt surgery response.
Multiple logistic regression analysis, controlling for age and sex (α = 0.05), showed that DESH score was significantly correlated (OR 1.77) with subjective shunt-surgery response at a minimum of 1-month follow-up. Patients with higher DESH scores were more likely to have a favorable response to shunt surgery.
Aggregating radiological markers into the DESH score is useful for predicting shunt responders among iNPH patients and can aid the selection of patients for surgery. These findings provide further support for the DESH score as a diagnostic tool for iNPH.
已有多种影像学标志物与特发性正常压力脑积水（iNPH）患者分流术后的临床改善相关。然而，iNPH 并无特征性表现，目前仍根据临床症状、影像学表现和有创辅助检查将患者诊断为可能、很可能或不太可能的病例。不成比例扩大的蛛网膜下腔脑积水（DESH）评分的预测价值尚未明确，但它可能提供了一种更准确的诊断方法。本回顾性队列研究旨在验证 DESH 评分对 iNPH 患者分流术后临床改善的预测能力。
我们回顾性地从 71 例行脑室-腹腔分流术的 iNPH 患者中获取了术前 MRI 和/或 CT 扫描。对 Evans 指数（EI）、胼胝体角（CA）、紧密高凸（THC）、大脑外侧裂扩张和局灶性脑沟扩张等影像学标志物进行评估，并将这些标志物进行聚合以确定 DESH 评分。通过患者的病历记录来主观确定步态功能、尿失禁和/或认知方面的改善程度，作为对分流手术反应的衡量标准。
多元逻辑回归分析（α=0.05），在控制年龄和性别后，显示 DESH 评分与主观分流手术反应（至少 1 个月随访时）显著相关（OR 1.77）。DESH 评分较高的患者更有可能对分流手术有良好的反应。
将影像学标志物聚合到 DESH 评分中有助于预测 iNPH 患者的分流手术应答者，并有助于为手术选择患者。这些发现进一步支持了 DESH 评分作为 iNPH 诊断工具的作用。
