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Neurological Surgery No Shinkei Geka Volume 33, Issue 6 （June 2005）

Neurological Surgery 脳神経外科 33巻6号（2005年6月発行）

Japanese English

研究

特発性正常圧水頭症における髄液流出抵抗値の再検討―硬膜外圧測定と腰部くも膜下腔髄液圧との比較 Reinvestigation of CSF Outflow Resistance Value in Idiopathic Normal Pressure Hydrocephalus: ―Comparing Epidural Pressure Monitoring with Lumbar Subarachnoid Cerebrospinal Fluid Pressure Monitoring― 竹内東太郎 ¹ , 後藤博美 ² , 伊崎堅志 ² , 国分康平 ² , 小田正哉 ² , 笹沼仁一 ² , 前野和重 ² , 菊地泰裕 ² , 小泉仁一 ² , 渡辺善一郎 ² , 伊藤康信 ² , 大原宏夫 ² , 古和田正悦 ² , 渡邊一夫 ² Totaro TAKEUCHI ¹ , Hiromi GOTO ² , Kenji IZAKI ² , Kohei KOKUBU ² , Masaya ODA ² , Jin-ichi SASANUMA ² , Kazushige MAENO ² , Yasuhiro KIKUCHI ² , Jin-ichi KOIZUMI ² , Zen-ichiro WATANABE ² , Yasunobu ITO ² , Hiroo OHARA ² , Masayoshi KOWADA ² , Kazuo WATANABE ² ¹財団法人脳神経疾患研究所附属南東北高度診断治療センター脳神経外科 ²財団法人脳神経疾患研究所附属総合南東北病院脳神経外科 ¹Department of Neurosurgery,The Southern TOHOKU High Degree Medical Center,Sourthern TOHOKU Research Institute for Neuroscience ²Department of Neurosurgery,The Sourhern TOHOKU General Hospital,Sourthern TOHOKU Research Institute for Neuroscience キーワード： normal pressure hydrocephalus , idiopathic , cerebrospinal fluid outflow resistance , epidural pressure , lumbar subarachnoid CSF pressure Keyword: normal pressure hydrocephalus , idiopathic , cerebrospinal fluid outflow resistance , epidural pressure , lumbar subarachnoid CSF pressure pp.579-584

発行日 2005年6月1日 Published Date 2005/6/1

DOI https://doi.org/10.11477/mf.1436100083

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　筆者らは特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）における術前シャント効果判定の中で，髄液流出抵抗値（cerebrospinal fluid outflow resistance value：Ro）を髄液循環障害の重要な判定因子と位置づけて測定してきた¹¹⁾．

　今回，筆者らはiNPHの診断および治療後経過観察における統一基準作成事業（study of idiopathic normal pressure hydrocephalus on neuro-logical improvement：SINPHONI）のオプションとしてRo施行基準が設定されたのを期にSINPHONIの施行基準でinfusion testを施行し，圧測定を従来の筆者らの頭蓋窮隆部硬膜外圧（convexity epidural pressure：EDP）¹¹⁾とSINPHONIの腰部くも膜下腔髄液圧（lumbar subarachnoidcerebrospinal fluid pressure：L-CSFP）を同時測定して両者におけるRoの比較検討を行ったので報告する．

Purpose To compare the cerebrospinal fluid (CSF) outflow resistance values (Ro) with epidural pressure (EDP) monitoring and lumbar subarachnoid　CSF pressure (L-CSFP) monitoring.

　Subjects and methods　The subjects were 14 patients with possible iNPH (age: 59-74years old,ratio of male and female 8:6). All the patients were subiected to an infusion test by a single bolus injection method (1ml/sec.,ΔV: 5 ml, t2: 2 min) as prescribed in the Standard of SINPHONI. EDP was monitored by continuous monitoring and the L-CSFP values By intermittent simple glass tube method (SINPHONI) were measured simultaneously. The Ro (RoEDP, RoL-CSFP) calculated from both methods, (1) the correlation of Ro and (2) the Ro threshold in a shunt effective group (E: nine cases) and a non effective group (NE, five cases) were compared.

　Results　(1) Although a favorable correlation was found between both Ro measurements (r=0.784), the RoEDP was always higher than the RoL-CSFP. (2) The mean Ro values in the E and NE groups were 36.8 ± 15.7 mmHg/ml/min, and 10 ± 2.05 mmHg/ml/min for Ro-EDP, 22.1 ± 13.95 mmHg/ml/min and 6.4 ± 1.7 mmHg/ml/min for RoL-CSFP, respectively. The approxilmate thresholds in the E and NE groups were 15 mmHg/ml/min for RoEDP and 10 mmHg/ml/min for RoL-CSFP.

　Conclusion　(1) Although the RoEDP is always higher than the RoL-CSFP, a favorable correlation is found between the RoEDP and RoL-CSFP, (2) The Ro thresholds of the E and NE groups in the infusion test are about 15 mmHg/ml/min for RoEDP and 10 mmHg/ml/min for RoL-CSFP. (3) After this, Ro calculation ought to execute by standard of SINPHONI and the Ro threshold of the E and NE groups is about 10 mmHg/ml/min.