The Clinical Analysis of Factors Predicting the Need for Shunting in Normal Pressure Hydrocephalus

The combination of gait disturbance,dementia and sphincteric urinary incontinence had been coined normal pressure(NPH) hydrocephalus which was developed idiopathic or secondary after subarachnoid hemorrhage,trauma, infection or postoperation.But compared with setting of clinical symptoms the pathophysiology and treatment modality of NPH were not cleared or unknown.The patients with NPH were shown to be treated by a CSF shunt operation.However,it is well known not all patients presenting the syndrome benefit from a shunt operation.In order to proper patients selection for shunt operation, various radiological and CSF dynamic investigations was essential to predict the outcome of the shunt operation.We selected patients with NPH and performed various diagnostic modalities from 1995 year to 2004 year.The purpose of the present study was to analysis factors predicting the need for shunting in NPH. Seventy-five patients with one ormore NPH symptoms were slected. For investigation of ventricular enlargement and CSF dynamics we measured Evan's ratio,periventricular low density and grade of sulci of Sylvian fissure and convexity in brain computed tomography or brain magnetic resonance image and performed radioisotope cisternography (RIC), 24 hours ICP monitoring and continuous external lumbar drainage. After decision of treatment modality we followed up patients with NPH during 3 months.The result of treatment outcome was estimated by Modified Stein and Langffit scale.The excellent group was defined two or more grades improvement,the good group was one grade improvement. The first operation decision criterias were Evan's ratio > 30% with periventricular low density reaching gray matterand 3 gradein RIC. The increased ICP or abnormalwaves (A- or B- wave) was the secondary operation criteria for the patientwith difference atypicalfindings of each radiologic studies. And symptoms improvement after continuous external lumbar drainage was the last operation criteria for the patients with difference finding of all imaging study and 24 hours ICP monitoring finding. In 24 cases selected by first criteria 23 cases (96%) were improved. In 9 cases selected by second criteria 7 cases (77%) were improved.In 17 cases selected by last criteria 15 cases (88%) improved. So, 90% (45 cases) of fifty shunt operated cases were improved. Nevertheless general shunt decision factors in the NPH were symptoms and radiologic findings,24 hours ICP monitoring finding and symptoms improvement during continuous external lumbar drainage were important operation decision factors forthe case with difference atypical findings. It was concluded that 24 hours ICP monitoring and continuous external lumbar drainage could predict which NPH patient will improve by a shunt operation and albeit to envisage the degree of improvement.

Author dc:creator

• 이, 응재

Contributors dc:contributor

• 조, 경기
• 대학원 의학과
• 200124157

• 정상압 수두증
• 동위원소 뇌조 촬영
• 지속적 24시간 뇌압감시
• 고식적 뇌척수액 배액
• 단락 수술

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000000587
000000000587

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1493