Guarracino Ilaria, Fabbro Sara, Piccolo Daniele, D'Agostini Serena, Skrap Miran, Belgrado Enrico, Vindigni Marco, Tuniz Francesco, Tomasino Barbara
Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, 33037 Pasian di Prato, Italy.
Neurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
Brain Sci. 2025 Jan 1;15(1):36. doi: 10.3390/brainsci15010036.
BACKGROUND/OBJECTIVES: Ventriculoperitoneal shunting is a validated procedure for the treatment of idiopathic normal-pressure hydrocephalus. To select shunt-responsive patients, infusion and tap tests can be used. Only gait is evaluated after the procedure to establish a potential improvement. In this study, we present our Hydro-Real-Time Neuropsychological Testing protocol to assess the feasibility of performing an ultra-fast assessment of patients during the infusion and tap test.
We tested 57 patients during the infusion and tap test to obtain real-time feedback on their cognitive status. Data were obtained immediately before the infusion phase (T0), when the pressure plateau was reached (T1), and immediately after cerebrospinal fluid subtraction (T2). Based on cerebrospinal fluid dynamics, 63.15% of the patients presented a resistance to outflow > 12 mmHg/mL/min, while 88% had a positive tap test response.
Compared to T0, cerebrospinal fluid removal significantly improved performance on tasks exploring executive functions (counting backward, < 0.001; verbal fluency, < 0.001). Patients were significantly faster at counting backward at T2 vs. T1 ( < 0.05) and at T2 vs. T0 ( < 0.001) and were significantly faster at counting forward at T2 vs. T1 ( < 0.005), suggesting an improvement in speed at T2. There was a significantly smaller index at T1 vs. T0 ( = 0.005) and at T2 vs. T0 ( < 0.001), suggesting a more marked improvement in patients' executive abilities at T2 and a smaller improvement at T1. Regarding verbal fluency, patients were worse at T1 vs. T0 ( < 0.001) and at T2 vs. T0 ( < 0.001).
Patients' performance can be monitored during the infusion and tap test as significant changes in executive functions are observable. In future, this protocol might help improve patients' selection for surgery.
背景/目的：脑室腹腔分流术是治疗特发性正常压力脑积水的有效方法。为了筛选出对分流术有反应的患者，可以采用灌注和放液试验。术后仅评估步态以确定是否有潜在改善。在本研究中，我们展示了我们的实时神经心理学测试方案，以评估在灌注和放液试验期间对患者进行超快速评估的可行性。
我们在灌注和放液试验期间对57名患者进行了测试，以获取他们认知状态的实时反馈。在灌注阶段开始前（T0）、达到压力平台期时（T1）以及脑脊液引流后立即（T2）获取数据。根据脑脊液动力学，63.15%的患者表现出流出阻力>12 mmHg/mL/min，而88%的患者放液试验反应呈阳性。
与T0相比，脑脊液引流显著改善了探索执行功能任务的表现（倒着数，<0.001；语言流畅性，<0.001）。患者在T2时倒着数比T1时显著更快（<0.05），且在T2时比T0时显著更快（<0.001），在T2时正着数比T1时显著更快（<0.005），表明在T2时速度有所提高。T1时与T0相比指数显著更小（=0.005），T2时与T0相比也显著更小（<0.001），表明患者在T2时执行能力有更明显改善，而在T1时改善较小。关于语言流畅性，患者在T1时比T0时更差（<0.001），在T2时比T0时也更差（<0.001）。
在灌注和放液试验期间可以监测患者的表现，因为可以观察到执行功能的显著变化。未来，该方案可能有助于改善手术患者的筛选。
