Neurological Surgery 脳神経外科48巻9号

2020年09月発行

総説

特発性正常圧水頭症のトピックス—超高齢社会への適応に向けたガイドライン改訂の要点

著者： 山田茂樹¹

所属機関： ¹滋賀医科大学脳神経外科学講座

ページ範囲：P.773 - P.780

Ⅰ．序論
　この20年で高齢化率が倍増し，介護提供者の不足が大きな問題となりつつあるわが国において，介護が必要となる3大要因「歩けない」「物忘れ」「尿失禁」を主症状とする特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）は，脳神経外科医にとって慢性硬膜下血腫とならび身近で診療する機会の多い疾患である．
　しかしながら，慢性硬膜下血腫の穿頭血腫除去術とは異なり，症状が進行してから髄液シャント手術を行っても介護が必要なくなるほどまでの回復は困難であり，早期発見と適切な時期に手術を勧めることが重要である．ただしiNPH患者は，転倒リスクが高いために入院中に日常生活動作が制限されやすく，手術にはさまざまなピットフォールがあり，万が一にも合併症を来すと，容易に歩行・認知機能の低下に陥る．またシャント術後も，バルブの設定圧を適宜変更して髄液排出量を適正に調整し，積極的なリハビリテーションを行い，退院後も長期的に患者とその家族に寄り添う医療が求められる．

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