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首页> 美国卫生研究院文献>Neurosurgery >DECREASES IN VENTRICULAR VOLUME CORRELATE WITH DECREASES IN VENTRICULAR PRESSURE IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS WHO EXPERIENCED CLINICAL IMPROVEMENT AFTER IMPLANTATION WITH ADJUSTABLE VALVE SHUNTS
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DECREASES IN VENTRICULAR VOLUME CORRELATE WITH DECREASES IN VENTRICULAR PRESSURE IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS PATIENTS WHO EXPERIENCED CLINICAL IMPROVEMENT AFTER IMPLANTATION WITH ADJUSTABLE VALVE SHUNTS

机译：特发性正常压迫性肝硬化患者经可调节瓣膜支架植入后的临床改善后其心室容量的减少与心室压力的减少相关

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>OBJECTIVE: This retrospective study examined whether changes in ventricular volume correspond with changes in adjustable valve pressure settings in a cohort of patients who received shunts to treat idiopathic normal pressure hydrocephalus. We also examined whether these pressure—volume curves and other patient variables would co-occur with a positive clinical response to shunting.>METHODS: We selected 51 patients diagnosed with idiopathic normal pressure hydrocephalus who had undergone implantation of a Codman Hakim programmable valve (Medos S.A., Le Locle, Switzerland). Clinical data were gathered from the patients’ records and clinical notes by an investigator blinded to patients’ ventricular volumes. Ventricular volume was measured using 3D Slicer, an image analysis and interactive visualization software package developed and maintained at the Surgical Planning Laboratory at Brigham and Women’s Hospital.>RESULTS: Eighty-six percent of patients with gait disturbance at presentation showed improvement of this symptom, 70% experienced improvement in incontinence, and 69% experienced improvement in dementia. For the group showing 100% clinical improvement, the correlation coefficient of average changes in valve pressure over time (ΔP/ΔT) and average changes in ventricular volume over time (ΔV/ΔT) were high at 0.843 (P < 0.05). For the group experiencing no or only partial improvement, the correlation coefficient was 0.257 (P = 0.32), indicating no correlation between average ΔV/ΔT and average ΔP/ΔT for each patient.>CONCLUSION: This was a carefully analyzed modeling study of idiopathic normal pressure hydrocephalus treatment made possible only by adjustable valve technology. With careful volumetric analysis, we found that changes in ventricular volume correlated with adjustments in valve pressure settings for those patients who improved clinically after shunting. This suggests that positive clinical responders retained parenchymal elasticity, emphasizing the importance of dynamic changes in this cohort.
机译：>目标：这项回顾性研究检查了一组接受分流治疗特发性正常压力脑积水的患者的心室容量变化是否与可​​调节的瓣膜压力设置变化相对应。我们还检查了这些压力-容量曲线和其他患者变量是否会与分流的临床反应同时发生。>方法：我们选择了51例经诊断为特发性正常压力脑积水的患者，他们接受了植入Codman Hakim可编程阀（瑞士Le Locle的Medos SA）。由对患者心室容积不知情的调查员从患者记录和临床记录中收集临床数据。心室容量使用3D Slicer进行测量，该图像分析和交互式可视化软件包由Bhamham and Women's Hospital的外科计划实验室开发并维护。>结果：演讲时有86％的步态障碍患者表现出这种症状的改善，70％的尿失禁得到改善，69％的痴呆得到改善。对于显示100％临床改善的组，瓣膜压力随时间的平均变化（ΔP/ΔT）与心室容积随时间的平均变化（ΔV/ΔT）的相关系数较高，为0.843（P <0.05）。对于没有或仅有部分改善的组，相关系数为0.257（P = 0.32），表明每位患者的平均ΔV/ΔT和平均ΔP/ΔT之间没有相关性。>结论：仔细分析特发性常压脑积水的建模研究只能通过可调瓣膜技术来实现。通过仔细的容积分析，我们发现，对于那些在分流后临床改善的患者，心室容积的变化与瓣膜压力设置的调整相关。这表明积极的临床反应者保留了实质弹性，强调了这一人群中动态变化的重要性。

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