neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-1-31-38neurosurgery-832Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTИнвазивная предоперационная диагностика идиопатической нормотензивной гидроцефалииInvasive preoperative diagnosis of idiopathic normal pressure hydrocephalushttps://orcid.org/0000-0002-8594-1533ГавриловГ. В.GavrilovG. V.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

gaspar_gavrilov@mail.ruhttps://orcid.org/0000-0002-6626-7707РадковМ. Н.RadkovM. N.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

ГайдарБ. В.GaydarB. V.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

https://orcid.org/0000-0002-3922-9887СвистовД. В.SvistovD. V.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

https://orcid.org/0000-0002-2615-269XСтанишевскийА. В. StanishevskiyA. V.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

https://orcid.org/0000-0003-4353-4953АверьяновД. А.AveryanovD. A.

194044 Санкт-Петербург, ул. Академика Лебедева, 6

6 Lebedeva St., Saint Petersburg 194044

ФГБВОУ ВО «Военно-медицинская академия им. С. М. Кирова» Минобороны РоссииРоссияS. M. Kirov Military Medical Academy, Ministry of Defense of RussiaRussian Federation2020110420202213138Copyright © Гаврилов Г.В., Радков М.Н., Гайдар Б.В., Свистов Д.В., Станишевский А.В., Аверьянов Д.А., 20202020Гаврилов Г.В., Радков М.Н., Гайдар Б.В., Свистов Д.В., Станишевский А.В., Аверьянов Д.А.Gavrilov G.V., Radkov M.N., Gaydar B.V., Svistov D.V., Stanishevskiy A.V., Averyanov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/832Введение

Введение. До настоящего времени наиболее информативными инструментами отбора пациентов для хирургического лечения идиопатической нормотензивной гидроцефалии (иНТГ) считаются инвазивные методы: tap-тест, инфузионно-нагрузочный тест, продленное наружное люмбальное дренирование. Однако последовательность их проведения и критерии оценки их результатов вызывают ряд вопросов у практикующих врачей.

Цель исследования – оценить информативность различных методов инвазивной диагностики иНТГ и составить алгоритм их последовательного применения.

Материалы и методы

Материалы и методы. В исследование включены 374 пациента, которые прошли лечение в клинике нейрохирургии Военно-медицинской академии им. С. М. Кирова с 2006 по 2018 г. и у которых использован хотя бы один из инвазивных методов диагностики иНТГ. Для проведения операции отобраны пациенты в возрасте 58–87 лет, которым был поставлен окончательный диагноз иНТГ (n = 231). Для каждого метода диагностики рассчитаны параметры информативности.

Результаты

Результаты. Чувствительность tap-теста составила 57,5 %, специфичность – 86,4 %, прогностическая значимость положительного результата – 92,5 %, отрицательного – 41,3 %, точность – 64,9 %. Чувствительность и специфичность инфузионно-нагрузочного теста составили 39,1 и 63,6 % соответственно; при относительно высокой прогностической значимости положительного результата (81,8 %) значимость отрицательного результата и точность оказались низкими (20,0 и 43,9 %). Продленное наружное люмбальное дренирование обладает наиболее высокой прогностической значимостью положительного результата (92,9 %).

Заключение

Заключение. Целесообразно исключить инфузионно-нагрузочный тест из алгоритма предоперационной диагностики иНТГ и рекомендовать последовательное применение tap-теста и продленного наружного люмбального дренирования (при недостаточной информативности tap-теста).

Introduction

Introduction. Until now, the most informative methods for selecting patients with idiopathic normal pressure (iNPH) for neurosurgical treatment were invasive diagnostic methods: tap test, lumbar infusion test, external lumbar drainage. Nevertheless, choosing the sequence of using these diagnostic tools and the assessment of their results cause number of questions for doctors in everyday practice.

The study objective is to assess the informational content of invasive tests for differential diagnosis of iNPH and to create an algorithm of applying mentioned methods for clinical purposes.

Materials and methods

Materials and methods. At least one of the invasive diagnostic methods was used for 374 patients, who were treated in the period from 2006 to 2018 in the neurosurgical clinic of S. M. Kirov Military Medical Academy. The patients with final diagnosis of iNPH (n = 231), aged 58–87 years old, were selected for shunt surgery. The informativeness measures were calculated for each method on the basis of revealed data.

Results

Results. Sensitivity and specificity of tap test were 57.5 and 86.4 %, respectively, positive predictive value – 92.5 %, negative predictive value – 41.3 %, accuracy – 64.9 %. For lumbar infusion test sensitivity was 39.1 %, specificity – 63.6 %, but we calculated low negative predictive value (20.0 %) and accuracy (43.9 %) of the method despite of relatively high positive predictive value (81.8 %). External lumbar drainage revealed the highest significance of positive predictive value (92.9 %).

Conclusion

Conclusion. Excluding of lumbar infusion test from the pre-operative diagnostic algorithm of iNPH and recommendation for sequential using of tap-test and external lumbar drainage after questionable result of the last one are an advisable option for practitioners.

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The authors declare that there are no conflicts of interest present.