正常压力脑积水的手术分流（附28例报告）

正常压力脑积水(Normal Pressure Hydro-cephalus NPH)是指颅内压力不超过180～200mmH_2O,但脑室扩大的交通性脑积水。关于其手术效果一直存在争议,我科自1994年至1999年共对28例此类患者行分流手术,报告如下。1 临床资料1.1 性别与年龄 男23例,女5例,年龄18～63岁,平均年龄38岁。1.2 发病原因 外伤致单纯蛛网膜下腔出血8例,脑挫裂伤3例,硬膜下血肿1例,肿瘤术后4例,自发性蛛网膜下腔出血6例,脑膜炎后2例,不明原因4例。     

正常压力脑积水分流手术32例疗效分析

目的探讨脑室-腹腔分流术治疗正常压力脑积水的效果。方法回顾性分析32例因正常压力脑积水行脑室-腹腔分流手术患者的临床资料。结果32例患者术后随访6个月至3年，10例显效，14例有效，8例无效；总有效率为75．0％（24／32），智能障碍患者的有效率为60．0％（6／10），步态不稳患者的有效率为80．0％（8／10），尿失禁患者的有效率为83．3％（10/12）。结论对正常压力脑积水患者，只要把握好手术适应证，尽早行脑室-腹腔分流术，可获得良好的疗效。     

老年人正常压力性脑积水的误诊与治疗探讨

老年人正常压力性脑积水与弥漫性大脑萎缩症常因临床症状表现相似、影像学检查表现相近。在临床工作中易被误诊，使老年人正常压力性脑积水得不到及时、有效的治疗。以下是我科收治的3例病人，现报道如下。     

可调压分流管治疗老年正常压力脑积水（附36例报告）

目的探讨体外可调压分流管治疗老年正常压力脑积水的临床效果。方法回顾性分析36例老年正常压力脑积水患者的临床资料,均应用体外可调压分流管行脑室-腹腔分流术。结果本组无手术死亡病例,未出现分流管堵塞、感染、排异反应等现象。术后随访3个月~1年,24例症状明显改善,生活自理;7例症状有改善,但生活不能自理;5例症状改善不明显或无改变。结论体外可调压分流管治疗老年正常压力脑积水安全、有效,术后对分流过度或分流不足的患者很容易进行调整。     

特发性正常压力脑积水36例诊治体会

特发性正常压力脑积水（INPH）是指无明确诱因的正常压力脑积水。有脑室扩大但脑脊液压力正常。以步态障碍、精神障碍、尿失禁为临床特征。其临床表现隐匿,好发于老年人,又与老年病相似,容易漏诊、误诊。一旦确诊,脑脊液分流手术效果良好。目前国际上对其诊断、     

特发性正常压力脑积水的诊断与治疗

特发性正常压力脑积水是一种原因不明的脑室扩大而脑脊液压力政党的脑积水,病理生理改变复杂,目前对其诊断与治疗还存在着较多争议.临床上主要根据病人症状、影像学表现、脑脊液动力学检查结果及颅内压临测进行诊断,治疗上脑脊液分流术为该疾病最有效的方法,然而还存在手术效果不确切,对可疑患者选择病例进行分流的困难.     

腰椎穿刺术在特发性正常压力脑积水治疗中的应用

目的探讨腰椎穿刺技术在老年人特发性正常压力脑积水治疗中的应用价值。方法回顾性分析54例特发性正常压力脑积水患者的临床资料。结果本组43例患者术后均得到6—12月随访,显效25例;有效18例;本组43例腰椎穿刺脑脊液放液试验症状改善患者手术有效率100％,术后患者步态障碍、尿失禁改善明显,智能障碍均有不同程度改善,影像学检查见脑室系统有不同程度缩小。结论腰椎穿刺放液试验是筛选特发性正常压力脑积水及预测手术疗效的有效方法。     

正常压力脑积水采用脑室-腹腔分流术的治疗效果分析

相关研究报道结果显示:采用脑室-腹腔分流术治疗正常压力脑积水的临床效果较好。鉴于此,为了进一步探讨正常压力脑积水采用脑室-腹腔分流术的临床效果,选取我院2007-11—2011-11入院治疗64例正常压力脑积水患者为研究对象,针对相关治疗效果进行比较分析,现将相关结果报告如下。     

侧脑室-腹腔分流术治疗正常压力脑积水28例

目的 探讨正常压力脑积水的手术治疗。方法 采用中、低压分流管行侧脑室-腹腔分流术。结果 本组28例，术后均得到6个月～3年随访，18例患者恢复正常生活，8例患者生活自理，2例患者术后症状无明显改善。结论 侧脑室-腹腔分流术是治疗正常压力脑积水最有效的方法。     

低颅内压脑积水的诊断及治疗

目的探讨低颅内压脑积水(LPH)的临床特征、发病机制和诊治方法。方法 2007年1月至2011年10月收治LPH患者7例,均采用可调压分流管行脑室-腹腔分流术(VPS)治疗,其中1例内引流前行脑室外引流术采取负压引流确诊,余6例均为正常压力脑积水内引流后随访中根据症状反复调压后确诊。结果本组7例VPS后随访3~33个月,除1例高龄患者(73岁)术后1年有轻度头昏、反应迟钝、智力下降外,余6例症状明显缓解,扩大脑室显著回缩。结论LPH临床少见,发病隐蔽,临床表现与正常颅压脑积水相类似;头部CT及MRI可表现为脑室扩大,部分甚至室周明显水肿;可调压管行VPS是治疗LPH的有效方法。     

侧脑室-腹腔分流术治疗正常压力脑积水28例

目的 探讨正常压力脑积水的手术治疗.方法 采用中、低压分流管行侧脑室-腹腔分流术.结果 本组28例,术后均得到6个月～3年随访,18例患者恢复正常生活,8例患者生活自理,2例患者术后症状无明显改善.结论 侧脑室-腹腔分流术是治疗正常压力脑积水最有效的方法.     

正常压力脑积水的临床特征和手术治疗

目的探讨正常压力脑积水(NPH)的临床特征和手术治疗效果。方法 NPH患者32例,其中17例应用中压分流管、15例用可调压分流管行脑室-腹腔分流术治疗。结果应用可调压分流管分流者的症状改善率为86.7%(13/15),应用中压分流管者为41.2%(7/17),两者相差显著(P<0.01)。结论应用可调压分流管行脑室-腹腔分流是治疗NPH的有效方法。     

脑室-腹腔分流术治疗外伤性正常压力性脑积水的疗效

目的探讨脑室-腹腔分流术(V-P分流术)治疗外伤性正常压力性脑积水的效果。方法回顾性分析48例外伤性正常压力性脑积水病人的临床资料,根据术前临床症状分为典型症状组和不典型症状组,均行V-P分流术,其中行去骨瓣减压术22例。并评估分流术后病情及预后情况。结果随访12个月,根据GOS评分,术后恢复良好12例,轻度残疾23例,重度残疾8例,植物生存3例,死亡2例。根据电话及门诊随访,病情改善41例(85.4%),病情无明显好转甚至恶化7例;其中典型症状组病情改善率100%,不典型症状组病情改善率72%。影像学检查提示:分流术后所有病人脑室均有不同程度缩小。22例行去骨瓣减压术的病人,分流术后6个月内均顺利行颅骨修补术,术后病情均明显改善。结论对外伤性正常压力性脑积水病人,把握好手术适应证,即使无典型临床症状,行V-P分流术后,大部分病人预后可获得改善。     

Features of gait most responsive to tap test in normal pressure hydrocephalus

OBJECTIVE: To identify components of gait associated with a positive tap test (TT) in patients with idiopathic normal pressure hydrocephalus (iNPH). PATIENTS AND METHODS: Thirty-three patients with iNPH underwent clinical evaluation pre- and post-TT and were classified as responders (Rs) or non-responders (NRs). Elements of gait were assessed with a formal standardized Gait Scale and compared between groups. RESULTS: Analysis of pre/post-TT group differences revealed an interaction for Total Gait Score and Walking Score, with improvements in responders only. Total Gait Scores improved by 29% in the Rs and 4.85% in the NRs. Rs showed significant post-TT improvements on a timed 10m walk, turning, and balance. Tandem walking, turning, truck balance and start stop hesitation showed trends toward improvement. CONCLUSIONS: The classic features of gait often used in determining diagnosis of NPH (wide based stride, reduced foot-floor clearance, and small steps) were not helpful in identifying responders to the TT. Walking speed, steps for turning, and tendency towards falling were most likely to improve post-TT. These straightforward measures can readily be adapted into clinical practice to assist in determination of shunt candidacy.     

Cerebral hemodynamics before and after shunting in normal pressure hydrocephalus

OBJECTIVE: To study the relationship between cerebral hemodynamics and clinical performance in normal pressure hydrocephalus (NPH), before and after surgery. MATERIAL AND METHODS: Ten patients were studied prospectively before and 3 months after shunt surgery by means of transcranial Doppler (TCD). Clinical performance was scored by means of an NPH scale and the modified Rankin scale. RESULTS: Peak systolic and mean cerebral blood flow velocity (MCV) were lower and cerebrovascular CO2 reactivity was higher after shunt surgery. The three patients with clinical improvement had higher preoperative end diastolic cerebral blood flow velocity and MCV. All postoperative cerebral blood flow velocities were higher in patients with clinical improvement. CONCLUSION: Our data suggest that higher cerebral blood flow velocity before surgery in patients with NPH is related to clinical improvement after shunt surgery. Cerebral hemodynamic parameters may develop into predictors of successful shunt surgery in patients with normal pressure hydrocephalus.     

侧脑室-腹腔分流术治疗正常压力脑积水

目的探讨正常压力脑积水(NPH)诊断和手术病例的选择方法,分析侧脑室-腹腔分流术治疗正常压力脑积水的效果。方法回顾性分析16例正常压力脑积水病人TAP试验前后步距、步速、转身步数,手术前后临床症状、KPS评分,腰穿测压和术中测压的结果。结果本组16例病人无手术死亡,无感染、脑内血肿,硬膜下积液1例。随访12个月,有效16例(100%),显效7例(43.75%)。结论正常压力脑积水的诊断和手术病例的选择需要综合分析临床资料;侧脑室-腹腔分流术能够改善病人临床症状,提高其生活质量。     

Giant cell arteritis and normal pressure hydrocephalus. A case report

The first known case of association of giant cell arteritis and normal pressure hydrocephalus is described. The arteritis was cured with corticosteroid therapy while hydrocephalus required ventriculo-peritoneal shunt. The high protein content of cerebrospinal fluid of this patient is probably the pathogenetic mechanism of cerebrospinal fluid block, leading to occult obstructive hydrocephalus.

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Sommario Descriviamo il primo caso noto di associazione di arterite a cellule giganti ed idrocefalo a pressione normale: la prima regredì con terapia cortisonica, il secondo rese necessario una derivazione liquorale. È probabile che la modificazione della componente proteica liquorale sia in questa paziente il movente patogenetico dell'instaurarsi di un idrocefalo ostruttivo occulto.