Boon A J, Tans J T, Delwel E J, Egeler-Peerdeman S M, Hanlo P W, Wurzer H A, Avezaat C J, de Jong D A, Gooskens R H, Hermans J
Department of Neurology, Westeinde Hospital, The Hague, The Netherlands.
J Neurosurg. 1998 Mar;88(3):490-5. doi: 10.3171/jns.1998.88.3.0490.
The goal of this prospective study was to compare outcome after placement of a low- or medium-pressure shunt in patients with normal-pressure hydrocephalus (NPH).
Ninety-six patients with NPH were randomized to receive a low-pressure ventriculoperitoneal shunt (LPV; 40 +/- 10 mm H2O) or medium high-pressure ventriculoperitoneal shunt (MPV; 100 +/- 10 mm H2O). The patients' gait disturbance and dementia were quantified by applying an NPH scale, and their level of disability was evaluated by using the modified Rankin scale (mRS). Patients were examined prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were determined by differences between preoperative and last NPH scale scores and mRS grades. The LPV and MPV shunt groups were compared by calculating both the differences between mean improvements and the proportions of patients showing improvement. Intention-to-treat analysis of mRS grades yielded a mean improvement of 1.27 +/- 1.41 for patients with LPV shunts and 0.68 +/- 1.58 for patients with MPV shunts (p = 0.06). Improvement was found in 74% of patients with LPV shunts and in 53% of patients with MPV shunts (p = 0.06) and a marked-to-excellent improvement in 45% of patients with LPV shunts and 28% of patients with MPV shunts (p = 0.12). All outcome measures indicated trends in favor of the LPV shunt group, with only the dementia scale reaching significance. After exclusion of serious events and deaths unrelated to NPH, efficacy analysis showed the advantage of LPV shunts to be diminished. Reduction in ventricular size was also significantly greater for patients in the LPV shunt group (p = 0.009). Subdural effusions occurred in 71% of patients with an LPV shunt and in 34% with an MPV shunt; however, their influence on patient outcome was limited.
Outcome was better for patients who had an LPV shunt than for those with an MPV shunt, although most differences were not statistically significant. The authors advise that patients with NPH be treated with an LPV shunt.
本前瞻性研究的目的是比较正常压力脑积水（NPH）患者植入低压或中压分流管后的治疗效果。
96例NPH患者被随机分为两组，分别接受低压脑室腹腔分流术（LPV；40±10mmH₂O）或中高压脑室腹腔分流术（MPV；100±10mmH₂O）。通过应用NPH量表对患者的步态障碍和痴呆进行量化，并使用改良Rankin量表（mRS）评估其残疾程度。在手术前以及术后1、3、6、9和12个月对患者进行检查。主要结局指标由术前和末次NPH量表评分及mRS分级之间的差异确定。通过计算平均改善差异和显示改善的患者比例，对LPV和MPV分流组进行比较。对mRS分级的意向性治疗分析显示，接受LPV分流术的患者平均改善1.27±1.41，接受MPV分流术的患者平均改善0.68±1.58（p = 0.06）。74%接受LPV分流术的患者和53%接受MPV分流术的患者有改善（p = 0.06），45%接受LPV分流术的患者和28%接受MPV分流术的患者有显著至极佳改善（p = 0.12）。所有结局指标均显示出有利于LPV分流组的趋势，只有痴呆量表达到显著水平。在排除与NPH无关的严重事件和死亡后，疗效分析显示LPV分流术的优势减弱。LPV分流组患者的脑室大小缩小也明显更大（p = 0.009）。71%接受LPV分流术的患者和34%接受MPV分流术的患者出现硬膜下积液；然而，它们对患者结局的影响有限。
接受LPV分流术的患者结局优于接受MPV分流术的患者，尽管大多数差异无统计学意义。作者建议NPH患者采用LPV分流术治疗。
