The Prediction of Shunt Response in Idiopathic Normal-Pressure Hydrocephalus Based on Intracranial Pressure Monitoring and Lumbar Infusion

ABSTRACT:Background:The cortical changes resulting from chronic hydrocephalus in adults are not well defined.Methods:Retrospective analysis of twenty-one patients (age 64-88 years) with a clinical diagnosis of “normal pressure hydrocephalus” who underwent cortical biopsy at the time of intracranial pressure monitoring or shunt insertion, and eight patients who were biopsied but not shunted. Eleven brains (age 26-92 years), seven from patients who could be considered to have “normal pressure hydrocephalus”, were also examined following autopsy. Age- and sex-matched control brains with small ventricles and no history of dementia were compared to the hydrocephalic brains. Senile plaques and neurofibrillary tangles were assessed semiquantitatively and a non-parametric statistical analysis was employed.Results:Five biopsies exhibited both senile plaques and rare neurofibrillary tangles, while two had only neurofibrillary tangles. Neurofibrillary tangles were more prevalent in hydrocephalic brains than in controls. There was no difference in the prevalence of senile plaques between the two groups. Grumose bodies in the substantia nigra were identified in five autopsy brains, a prevalence higher than in control brains.Conclusions:These pathological features are not specific for hydrocephalus; however, they suggest that long-standing ventriculomegaly is associated with degenerative brain changes in sites beyond the periventricular white matter. The presence of senile plaques in cortical biopsies from hydrocephalic patients does not appear to be a contraindication to shunting; however a prospective study in patients undergoing intracranial pressure monitoring would better address the issue.

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O.053 Simultaneous monitoring of cerebral energy metabolism (microdialysis) and intracranial pressure (ICP) in idiopathic normal pressure hydrocephalus (iNPH)

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(08)70058-1 ◽

2008 ◽

Vol 110 ◽

pp. S14

Author(s):

P.K. Eide ◽

M. Stanisic

Keyword(s):

Energy Metabolism ◽

Intracranial Pressure ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cerebral Energy Metabolism

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Normalized power variance of eLORETA at high-convexity area predicts shunt response in idiopathic normal pressure hydrocephalus

Scientific Reports ◽

10.1038/s41598-020-70035-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yasunori Aoki ◽

Hiroaki Kazui ◽

Ricardo Bruña ◽

Roberto D. Pascual-Marqui ◽

Kenji Yoshiyama ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Power Variance ◽

Shunt Response

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Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery

Journal of Neurosurgery ◽

10.3171/2009.5.jns09122 ◽

2010 ◽

Vol 112 (2) ◽

pp. 414-424 ◽

Cited By ~ 25

Author(s):

Per K. Eide ◽

Milo Stanisic

Keyword(s):

Intracranial Pressure ◽

Normal Pressure Hydrocephalus ◽

Wave Amplitude ◽

Cerebral Metabolism ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Clinical Severity ◽

Cerebral Microdialysis ◽

Shunt Surgery ◽

Lumbar Drainage

Object This study was performed in patients with idiopathic normal-pressure hydrocephalus (iNPH) to monitor cerebral metabolism with microdialysis (MD) and intracranial pressure (ICP) readings, and relate to the clinical responses to extended lumbar drainage (ELD) and shunt surgery. Methods The baseline levels of MD metabolites and ICP were monitored overnight in 40 consecutive patients with iNPH. In a subset of 28 patients, monitoring was continued during 3 days of ELD. Thirty-one patients received a ventriculoperitoneal shunt. The clinical severity of iNPH was determined before and then 3 and 6–12 months after shunt surgery. Results Altered levels of MD markers (lactate, pyruvate, lactate/pyruvate ratio, glutamate, and/or glycerol) were seen in all patients at baseline; these improved during ELD. Despite normal static ICP (mean ICP), the pulsatile ICP (the ICP wave amplitude) was increased in 24 patients (60%). Only the level of the ICP wave amplitude differentiated the ELD and/or shunt responders from nonresponders. Conclusions The MD monitoring indicated low-grade cerebral ischemia in patients with iNPH; during ELD, cerebral metabolism improved. The pulsatile ICP (the ICP wave amplitude) was the only variable differentiating the clinical responders from the nonresponders. The authors suggest that the pulsatile ICP reflects the intracranial compliance and that CSF diversion improves the biophysical milieu of the nerve cells, which subsequently may improve their biochemical milieu.

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