Предикторы удовлетворительного исхода хирургического лечения идиопатической нормотензивной гидроцефалии (обзор)

Идиопатическая нормотензивная гидроцефалия — распространенное среди пожилых лиц нейродегенеративное заболевание, приводящее в отсутствие своевременного хирургического лечения к существенному снижению качества жизни и инвалидизации. Согласно существующим отечественным и зарубежным клиническим рекомендациям, отбор кандидатов для выполнения ликворошунтирующей операции проводится в том числе на основании результатов инвазивных методов диагностики, при этом результаты лечения не всегда оптимальны. В то же время в последнее десятилетие публикуется все большее количество исследований о перспективных методах неинвазивной диагностики и прогнозирования течения идиопатической нормотензивной гидроцефалии на основании данных нейровизуализации.

Цель настоящего систематического обзора — показать наиболее перспективные интраскопические предикторы удовлетворительного исхода ликворошунтирующих операций у пациентов с идиопатической нормотензивной гидроцефалией на основании анализа литературных сведений.

1. Клинические рекомендации. Лечение нормо­тензив­ной гидроцефалии у взрослых. Под ред. Легздайна М.А., Гаврилова Г.В., Свистова Д.В. СПб; 2015.
2. Hebb A.O., Cusimano M.D. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 2001; 49(5): 1166–1184, https://doi.org/10.1097/00006123-200111000-00028.
3. Toma A.K., Papadopoulos M.C., Stapleton S., Kitchen N.D., Watkins L.D. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien) 2013; 155(10): 1977–1980, https://doi.org/10.1007/s00701-013-1835-5.
4. Eide P.K., Sorteberg W. Outcome of surgery for idiopathic normal pressure hydrocephalus: role of preoperative static and pulsatile intracranial pressure. World Neurosurg 2016; 86: 186–193.e1, https://doi.org/10.1016/j.wneu.2015.09.067.
5. Giordan E., Palandri G., Lanzino G., Murad M.H., Elder B.D. Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. J Neurosurg 2018; 131(4): 1024–1036, https://doi.org/10.3171/2018.5.jns1875.
6. Hong Y.J., Kim M.J., Jeong E., Kim J.E., Hwang J., Lee J.I., Lee J.H., Na D.L. Preoperative biomarkers in patients with idiopathic normal pressure hydrocephalus showing a favorable shunt surgery outcome. J Neurol Sci 2018; 387: 21–26, https://doi.org/10.1016/j.jns.2018.01.017.
7. Greuter L., Schenker T., Guzman R., Soleman J. Endoscopic third ventriculostomy compared to ventriculoperitoneal shunt as treatment for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Br J Neurosurg 2022; 1–7, https://doi.org/10.1080/02688697.2022.2149697.
8. Жаде С.А., Хуршудян Э.Р., Зяблова Е.И., Тка­чев В.В., Музлаев Г.Г. Дифференциальный диагноз синдрома нормотензивной гидроцефалии. Инновационная медицина Кубани 2017; 8(4): 46–52.
9. Kimura T., Yamada S., Sugimura T., Seki T., Miyano M., Fukuda S., Takeuchi S., Miyata S., Tucker A., Fujita T., Hashizume A., Izumi N., Kawasaki K., Nakagaki A., Sako K. Preoperative predictive factors of short-term outcome in idiopathic normal pressure hydrocephalus. World Neurosurg 2021; 151: e399–e406, https://doi.org/10.1016/j.wneu.2021.04.055.
10. Chidiac C., Sundström N., Tullberg M., Arvidsson L., Olivecrona M. Waiting time for surgery influences the outcome in idiopathic normal pressure hydrocephalus — a population-based study. Acta Neurochir (Wien) 2022; 164(2): 469–478, https://doi.org/10.1007/s00701-021-05085-7.
11. Rovira À., Hodel J. Commentary: predictor of shunt response in idiopathic normal pressure hydrocephalus. Neuroradiology 2022; 64(11): 2097–2099, https://doi.org/10.1007/s00234-022-03051-3.
12. Halperin J.J., Kurlan R., Schwalb J.M., Cusimano M.D., Gronseth G., Gloss D. Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2015; 85(23): 2063–2071, https://doi.org/10.1212/wnl.0000000000002193.
13. Nakajima M., Yamada S., Miyajima M., Ishii K., Kuriyama N., Kazui H., Kanemoto H., Suehiro T., Yoshiyama K., Kameda M., Kajimoto Y., Mase M., Murai H., Kita D., Kimura T., Samejima N., Tokuda T., Kaijima M., Akiba C., Kawamura K., Atsuchi M., Hirata Y., Matsumae M., Sasaki M., Yamashita F., Aoki S., Irie R., Miyake H., Kato T., Mori E., Ishikawa M., Date I., Arai H.; Research committee of idiopathic normal pressure hydrocephalus. Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo) 2021; 61(2): 63–97, https://doi.org/10.2176/nmc.st.2020-0292.
14. Thavarajasingam S.G., El-Khatib M., Rea M., Russo S., Lemcke J., Al-Nusair L., Vajkoczy P. Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir (Wien) 2021; 163(10): 2641–2672, https://doi.org/10.1007/s00701-021-04922-z.
15. Jakopin N.E., Myong E., Bogucki T., Gray D., Gross P., McComb J.G., Shannon C.N., Tamber M.S., Toyama M., van der Willigen T., Yazdani A., Hamilton M.G., Koschnitzky J.E. Establishing ranked priorities for future hydrocephalus research. J Neurosurg 2022; 139(2): 492–501, https://doi.org/10.3171/2022.10.jns22753.
16. Wu D., Moghekar A., Shi W., Blitz A.M., Mori S. Systematic volumetric analysis predicts response to CSF drainage and outcome to shunt surgery in idiopathic normal pressure hydrocephalus. Eur Radiol 2021; 31(7): 4972–4980, https://doi.org/10.1007/s00330-020-07531-z.
17. Пашкова А.А., Фокин В.А., Ефимцев А.Ю., Гаври­лов Г.В., Труфанов А.Г. Возможности многовоксельной морфометрии в оценке серого вещества у больных гидроцефалией. Вестник Российской Военно-медицинской академии 2012; 3: 201–205.
18. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., Li T., Loder E.W., Mayo-Wilson E., McDonald S., McGuinness L.A., Stewart L.A., Thomas J., Tricco A.C., Welch V.A., Whiting P., Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71, https://doi.org/10.1136/bmj.n71.
19. Chen J., He W., Zhang X., Lv M., Zhou X., Yang X., Wei H., Ma H., Li H., Xia J. Value of MRI-based semi-quantitative structural neuroimaging in predicting the prognosis of patients with idiopathic normal pressure hydrocephalus after shunt surgery. Eur Radiol 2022; 32(11): 7800–7810, https://doi.org/10.1007/s00330-022-08733-3.
20. Snöbohm C., Malmberg F., Freyhult E., Kultima K., Fällmar D., Virhammar J. White matter changes should not exclude patients with idiopathic normal pressure hydrocephalus from shunt surgery. Fluids Barriers CNS 2022; 19(1): 35, https://doi.org/10.1186/s12987-022-00338-8.
21. Laticevschi T., Lingenberg A., Armand S., Griffa A., Assal F., Allali G. Can the radiological scale “iNPH Radscale” predict tap test response in idiopathic normal pressure hydrocephalus? J Neurol Sci 2021; 420: 117239, https://doi.org/10.1016/j.jns.2020.117239.
22. Skalický P., Vlasák A., Mládek A., Vrána J., Bajaček M., Whitley H., Beneš V., Bradáč O. Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients. J Clin Neurosci 2021; 83: 99–107, https://doi.org/10.1016/j.jocn.2020.11.020.
23. Agerskov S., Wallin M., Hellström P., Ziegelitz D., Wikkelsö C., Tullberg M. Absence of disproportionately enlarged subarachnoid space hydrocephalus, a sharp callosal angle, or other morphologic MRI markers should not be used to exclude patients with idiopathic normal pressure hydrocephalus from shunt surgery. AJNR Am J Neuroradiol 2019; 40(1): 74–79, https://doi.org/10.3174/ajnr.a5910.
24. Ahmed A.K., Luciano M., Moghekar A., Shin J., Aygun N., Sair H.I., Rigamonti D., Blitz A.M. Does the presence or absence of DESH predict outcomes in adult hydrocephalus? AJNR Am J Neuroradiol 2018; 39(11): 2022–2026, https://doi.org/10.3174/ajnr.a5820.
25. Benedetto N., Gambacciani C., Aquila F., Di Carlo D.T., Morganti R., Perrini P. A new quantitative method to assess disproportionately enlarged subarachnoid space (DESH) in patients with possible idiopathic normal pressure hydrocephalus: the SILVER index. Clin Neurol Neurosurg 2017; 158: 27–32, https://doi.org/10.1016/j.clineuro.2017.04.015.
26. Craven C.L., Toma A.K., Mostafa T., Patel N., Watkins L.D. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci 2016; 34: 294–298, https://doi.org/10.1016/j.jocn.2016.09.004.
27. Kojoukhova M., Koivisto A.M., Korhonen R., Remes A.M., Vanninen R., Soininen H., Jääskeläinen J.E., Sutela A., Leinonen V. Feasibility of radiological markers in idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2015; 157(10): 1709–1718, https://doi.org/10.1007/s00701-015-2503-8.
28. Thavarajasingam S.G., El-Khatib M., Vemulapalli K., Iradukunda H.A.S., Sajeenth V.K., Borchert R., Russo S., Eide P.K. Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165(2): 369–419, https://doi.org/10.1007/s00701-022-05402-8.
29. Johannsson B., Munthe S., Poulsen F.R., Pedersen C.B. Idiopathic normal pressure hydrocephalus; treatment and outcome in the Region of Southern Denmark. Clin Neurol Neurosurg 2022; 213: 107107, https://doi.org/10.1016/j.clineuro.2021.107107.
30. Mantovani P., Giannini G., Milletti D., Cevoli S., Valsecchi N., Gramegna L.L., Albini-Riccioli L., Sturiale C., Cortelli P., Lanzino G., Elder B.D., Palandri G.; PRO-HYDRO Study Group. Anterior callosal angle correlates with gait impairment and fall risk in iNPH patients. Acta Neurochir (Wien) 2021; 163(3): 759–766, https://doi.org/10.1007/s00701-020-04699-7.
31. Subramanian H.E., Fadel S.A., Matouk C.C., Zohrabian V.M., Mahajan A. The utility of imaging parameters in predicting long-term clinical improvement after shunt surgery in patients with idiopathic normal pressure hydrocephalus. World Neurosurg 2021; 149: e1–e10, https://doi.org/10.1016/j.wneu.2021.02.108.
32. Wolfsegger T., Hauser A., Wimmer S., Neuwirth K., Assar H., Topakian R. A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2021; 201: 106402, https://doi.org/10.1016/j.clineuro.2020.106402.
33. Гаврилов Г.В., Станишевский А.В., Гайдар Б.В., Свистов Д.В., Бабичев К.Н., Адлейба Б.Г. Комплексный анализ МРТ-признаков в дифференциальной диагностике идиопатической нормотензивной гидроцефалии. Предикторы эффективности хирургического лечения. Нейрохирургия 2019; 21(3): 44–51, https://doi.org/10.17650/1683-3295-2019-21-3-44-51.
34. Grahnke K., Jusue-Torres I., Szujewski C., Joyce C., Schneck M., Prabhu V.C., Anderson D.E. The quest for predicting sustained shunt response in normal-pressure hydrocephalus: an analysis of the callosal angle’s utility. World Neurosurg 2018; 115: e717–e722, https://doi.org/10.1016/j.wneu.2018.04.150.
35. Shinoda N., Hirai O., Hori S., Mikami K., Bando T., Shimo D., Kuroyama T., Kuramoto Y., Matsumoto M., Ueno Y. Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure hydrocephalus: clinical research. J Neurosurg 2017; 127(6): 1436–1442, https://doi.org/10.3171/2016.9.jns161080.
36. Garcia-Armengol R., Domenech S., Botella-Campos C., Goncalves F.J., Menéndez B., Teixidor P., Muñoz-Narbona L., Rimbau J. Comparison of elevated intracranial pressure pulse amplitude and disproportionately enlarged subarachnoid space (DESH) for prediction of surgical results in suspected idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2016; 158(11): 2207–2213, https://doi.org/10.1007/s00701-016-2858-5.
37. Narita W., Nishio Y., Baba T., Iizuka O., Ishihara T., Matsuda M., Iwasaki M., Tominaga T., Mori E. High-convexity tightness predicts the shunt response in idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 2016; 37(10): 1831–1837, https://doi.org/10.3174/ajnr.a4838.
38. Virhammar J., Laurell K., Cesarini K.G., Larsson E.M. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 2014; 35(12): 2311–2318, https://doi.org/10.3174/ajnr.a4046.
39. Komotar R.J., Zacharia B.E., Mocco J., Kaiser M.G., Frucht S.J., McKhann G.M. II. Cervical spine disease may result in a negative lumbar spinal drainage trial in normal pressure hydrocephalus: case report. Neurosurgery 2008; 63(4 Suppl 2): 315, https://doi.org/10.1227/01.neu.0000327030.72226.d6.
40. Eide P.K., Sorteberg W. Invasive tests for predicting shunt response in idiopathic normal pressure hydrocephalus: the risk aspect. Acta Neurochir (Wien) 2022; 164(2): 481–482, https://doi.org/10.1007/s00701-021-05050-4.
41. Vakili S., Moran D., Hung A., Elder B.D., Jeon L., Fialho H., Sankey E.W., Jusué-Torres I., Goodwin C.R., Lu J., Robison J., Rigamonti D. Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term benefit. Neurosurg Focus 2016; 41(3): E2, https://doi.org/10.3171/2016.6.focus16146.
42. Carlsen J.F., Munch T.N., Hansen A.E., Hasselbalch S.G., Rykkje A.M. Can preoperative brain imaging features predict shunt response in idiopathic normal pressure hydrocephalus? A PRISMA review. Neuroradiology 2022; 64(11): 2119–2133, https://doi.org/10.1007/s00234-022-03021-9.
43. Шахнович А.Р., Шахнович В.А. Церебро-венозная ортостатическая реактивность (ЦВОР) при гидроцефалии и внутричерепной гипертензии. Нейрохирургия и неврология детского возраста 2013; 3: 11–25.
44. Ishii K., Kanda T., Harada A., Miyamoto N., Kawaguchi T., Shimada K., Ohkawa S., Uemura T., Yoshikawa T., Mori E. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus. Eur Radiol 2008; 18(11): 2678–2683, https://doi.org/10.1007/s00330-008-1044-4.
45. Kockum K., Lilja-Lund O., Larsson E.M., Rosell M., Söderström L., Virhammar J., Laurell K. The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation. Eur J Neurol 2018; 25(3): 569–576, https://doi.org/10.1111/ene.13555.
46. Алиев З.Ш., Гаврилов Г.В., Свистов Д.В. Применение систем искусственного интеллекта в диагностике идиопатической нормотензивной гидроцефалии. Российский нейрохирургический журнал им. профессора А.Л. Поленова 2022; 14(S1): 111–112.

Stanishevskiy А.V., Gavrilov G.V., Radkov M.N., Adlejba B.G., Svistov D.V. Predictors of Satisfactory Surgical Outcome in Idiopathic Normal Pressure Hydrocephalus (Review). Sovremennye tehnologii v medicine 2024; 16(2): 68, https://doi.org/10.17691/stm2024.16.2.07