Raftopoulos C, Deleval J, Chaskis C, Leonard A, Cantraine F, Desmyttere F, Clarysse S, Brotchi J
Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium.
Neurosurgery. 1994 Sep;35(3):397-404; discussion 404-5. doi: 10.1227/00006123-199409000-00006.
Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.
特发性正常压力脑积水仍然难以治疗。关于分流是否真的能改善认知功能以及定量颅内压监测（ICP-Mo）能否预测术后改善率存在争议。多项研究已关注到缺乏关于这种疾病手术结果的前瞻性研究。我们对基于ICP-Mo在出现“高”波（振幅>9 mmHg）时进行分流的特发性正常压力脑积水患者进行了这样一项研究。23例患者接受了手术。术前和术后临床状态通过对ICP-Mo结果不知情的定量程序进行评估。1年后，96%的患者分流后有明显改善，高波相对频率与改善程度之间存在统计学显著相关性（P<0.05）。同时，66.6%的分流患者认知功能有显著改善。在本系列中，分流并发症得到成功处理，无残留缺陷。我们建议使用定量ICP-Mo作为手术标准并预测改善程度。
