| Background and ObjectiveNormal pressure hydrocephalus(NPH)is a group of clinical syndromes with normal or slightly high intracranial pressure and a series of hydrocephalus imaging characteristics and clinical manifestations.It's classified as idiopathic normal pressure hydrocephalus(iNPH)and secondary normal pressure hydrocephalus(sNPH)according to the etiology.The cause of iNPH is still unclear.It mainly occurring in elderly patients,and its typical clinical manifestations are Hakim triad: gait disorder,cognitive impairment and urinary incontinence.The sNPH usually secondary to traumatic brain injury,cerebrovascular disease and subarachnoid hemorrhage,etc.,which can occur at any age.Because most sNPH patients have severe primary brain injury,sNPH is often unable to be evaluated by the Hakim triad,and its diagnosis and treatment tend to lag behind the development of the disease.Currently,the treatment of NPH is mainly by ventriculoperitoneal shunt(VPS).However,in recent years,lumboperitoneal shunt(LPS)has been gradually recognized and widely used in the treatment of NPH at home and abroad due to its significant advantages.Although both iNPH and sNPH are belong to NPH,and their treatment is both dominated by shunt surgery,there are great differences in their etiology,diagnosis,curative effect and prognosis.They are similar but should not be confused.At present,most studies do not clearly distinguish them,and the understanding of them is still insufficient,which causing some confusion.In this study,the clinical data of two kinds of NPH patients treated with LPS were retrospectively analyzed,so as to explore the clinical value of LPS treatment for iNPH and sNPH for clinical practice.Materials and methods1 Clinical data of 95 sNPH patients admitted to the Neurosurgery Department of the Fifth Affiliated Hospital of Zhengzhou University from June 2015 to June 2018 were collected.Among them,37 cases were treated with LPS in the observation group and 58 cases with VPS in the control group.The postoperative efficacy,complication rate and secondary operation rate of the two groups were compared and analyzed,and the survival status of the two groups was compared and analyzed by Kaplan-Meier survival analysis method.2 Clinical data of 26 patients with iNPH treated with LPS in the Department of Neurosurgery of the Fifth Affiliated Hospital of Zhengzhou University from June 2015 to June 2018 were collected and analyzed.The improvement of clinical symptoms was evaluated by 10 m walking test,mini-mental state examination(MMSE)and idiopathic normal pressure grade scale(iNPHGS).The improvement of ventricular imaging was evaluated by Evans' index(EI)and callosal angle(CA).The improvement of prognosis was assessed by modified Rankin scale(MRS)and Glasgow outcome scale(GOS).And the incidence of complications within 6 months after LPS was calculated.Results1 After surgery,the total effective rate was 91.9% in the LPS group and 91.4% in the VPS group.There was no statistically significant difference between the 2 groups(P>0.05).The incidence of postoperative complications was 10.8% in the LPS group and 29.3% in the VPS group,the difference was statistically significant(P<0.05).The secondary operation rate was 2.7% in LPS group and 15.5% in VPS group,and the difference was statistically significant(P<0.05).The difference of survival curve between the two groups was statistically significant(P<0.05).2 Compared with preoperative,in terms of clinical symptoms,the time(18.939±1.516 vs.26.316±2.104 s)and step number(32.468±1.025 vs.40.816±2.714)of 10 m reentrant walking test,MMSE score(26.821±3.104 vs.21.105±2.112)and iNPHGS(2.962±1.112 vs.5.692±2.015)of the patients were statistically significant(P<0.001).In terms of ventricular size,postoperative EI(0.301±0.029 vs.0.381±0.035)and CA(102.713±7.586 vs.72.154±12.625)of the patients were statistically significant(P<0.001).In terms of prognosis,postoperative MRS(1.731±0.862 vs.2.577±1.071)and GOS(4.321±0.316 vs.3.572±0.718)of the patients were statistically significant(P<0.001).A total of 2 patients(7.69%)developed postoperative complications within 6 months after surgery,without death,infection,shunt blockage and other serious postoperative complications.Conclusions1 Both LPS and VPS have good efficacy in the treatment of secondary normal pressure hydrocephalus,but the incidence of postoperative complications and the rate of secondary surgery of LPS are lower than that of VPS,which can improve the prognosis of patients to a certain extent.LPS is recommended when there is no obvious contraindication.2 LPS can significantly improve the clinical symptoms and ventricle size of iNPH patients,improve the overall life ability and prognosis of patients,and reduce the incidence of complications,which is an effective surgical method for iNPH treatment and worthy of further study. |
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