特発性正常圧水頭症における髄液シャント術の予後予測

Preoperative Predictors of Outcomes of Cerebrospinal Fluid Shunt Surgery in Patients with Idiopathic Normal Pressure Hydrocephalus

特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）におけるDESH（disproportionately enlarged subarachnoid-space hydrocephalus）の所見は，iNPH患者に対する髄液シャント術の有効性をある程度予測することができる。しかしながら，DESHの有無によらずiNPHではアルツハイマー病やレビー小体病の併存が多いことが近年明らかになり，これらの併存は術後の転機不良因子ではないかと考えられている。さらに，iNPH患者における髄液シャント術の長期予後はいまだ不明のままであり，その解明は今後の最も大きな課題の1つである。

Abstract

The disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings on cranial images are useful to predict cerebrospinal fluid (CSF) shunt responsiveness to some extent in patients with idiopathic normal-pressure hydrocephalus (iNPH). However, recent studies show that patients with iNPH often have concomitant Alzheimer's or Lewy body disease regardless of DESH findings, which may be associated with poor outcomes of CSF shunt surgery. Moreover, long-term outcomes after CSF shunt surgery in patients with iNPH, which is one of the most important issues to be addressed for effective treatment of iNPH, remain unknown.