Cerebrospinal fluid outflow resistance measurements in the selection of patients for shunt surgery in the normal pressure hydrocephalus syndrome. A controlled trial

1990 ◽  
Vol 104 (1-2) ◽  
pp. 48-53 ◽  
Author(s):  
M. Kosteljanetz ◽  
A. -M. Nehen ◽  
J. Kaalund
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Controlled Trial ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Outflow Resistance ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Ville Leinonen ◽  
Lata G. Menon ◽  
Rona S. Carroll ◽  
Donna Dello Iacono ◽  
Jeremy Grevet ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Csf Biomarkers ◽  
Cerebrospinal Fluid Biomarkers ◽  
In The Beginning ◽  
Related Proteins ◽  
Selection Of Patients ◽  
Selection Of

The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is still challenging. Alzheimer's disease (AD), along with vascular dementia, the most important differential diagnosis for iNPH, has several potential cerebrospinal fluid (CSF) biomarkers which might help in the selection of patients for shunt treatment. The aim of this study was to compare a battery of CSF biomarkers including well-known AD-related proteins with CSF from patients with suspected iNPH collected from the external lumbar drainage test (ELD). A total of 35 patients with suspected iNPH patients were evaluated with ELD. CSF was collected in the beginning of the test, and the concentrations of total tau, ptau181, Aβ42, NFL, TNF-α, TGFβ1, and VEGF were analysed by ELISA. Twenty-six patients had a positive ELD result—that is, their gait symptoms improved; 9 patients had negative ELD. The levels of all analyzed CSF biomarkers were similar between the groups and none of them predicted the ELD result in these patients. Contrary to expectations lumbar CSF TNF-αconcentration was low in iNPH patients.

Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus

1979 ◽  
Vol 50 (4) ◽  
pp. 489-493 ◽  
Author(s):  
Svend Erik Børgesen ◽  
Flemming Gjerris ◽  
Søren Claus Sørensen
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Intraventricular Pressure ◽  
Content Type ◽  
Normal Limits ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print ◽  
High Conductance

✓ Forty patients with clinical evidence of normal-pressure hydrocephalus were studied by monitoring intraventricular pressure during a 24-hour period, and by a lumboventricular perfusion test for measurement of the conductance to outflow of cerebrospinal fluid (CSF). The purpose of the study was to investigate whether there is a relationship between intraventricular pressure and conductance to outflow of CSF, and whether it is possible to use the results from pressure monitoring in the selection of patients who may be expected to benefit from shunting therapy. The conductance to outflow was used as an evaluation factor in the selection of patients to be treated by a shunt. The conductance to CSF outflow differed by twelvefold between the lowest and highest values. The level of resting intraventricular pressure was within normal limits in all patients. Accordingly, there was no evidence of a relationship between conductance to outflow and intraventricular pressure. So-called B-waves were seen more frequently in patients with decreased conductance to outflow, but were also present in patients with high conductance to outflow. Therefore, the presence of B-waves does not imply a low conductance to outflow of CSF.

The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus

2014 ◽  
Vol 120 (1) ◽  
pp. 178-184 ◽  
Author(s):  
Johan Virhammar ◽  
Katarina Laurell ◽  
Kristina Giuliana Cesarini ◽  
Elna-Marie Larsson
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Posterior Commissure ◽  
Coronal Image ◽  
Brain Scans ◽  
Prognostic Accuracy ◽  
Neuroimaging Biomarkers ◽  
Selection Of

Object Different neuroimaging biomarkers have been studied to find a tool for prediction of response to CSF shunting in idiopathic normal-pressure hydrocephalus (iNPH). The callosal angle (CA) has been described as useful in discriminating iNPH from ventricular dilation secondary to atrophy. However, the usefulness of the CA as a prognostic tool for the selection of shunt candidates among patients with iNPH is unclear. The aim of this study was to compare the CA in shunt responders with that in nonresponders and clarify whether the CA can serve as a predictor of the outcome. Methods Preoperative MRI brain scans were evaluated in 109 patients who had undergone shunt surgery for iNPH during 2006–2010. Multiplanar reconstruction was performed interactively to obtain a coronal image through the posterior commissure, perpendicular to the anterior-posterior commissure plane. The CA was measured as the angle between the lateral ventricles on the coronal image. The patients were examined clinically before surgery and at 12 months postoperatively. Results Shunt responders had a significantly smaller mean preoperative CA compared with nonresponders: 59° (95% CI 56°–63°) versus 68° (95% CI 61°–75°) (p < 0.05). A CA cutoff value of 63° showed the best prognostic accuracy. Conclusions The preoperative CA is smaller in patients whose condition improves after shunt surgery and may be a useful tool in the selection of shunt candidates among patients with iNPH.

scholarly journals Cerebral Autoregulation, CSF outflow resistance and outcome following CSF diversion in Normal Pressure Hydrocephalus

2017 ◽  
Author(s):  
Afroditi Despina Lalou ◽  
Marek Czosnyka ◽  
Joseph Donnelly ◽  
John D. Pickard ◽  
Eva Nabbanja ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Cerebral Autoregulation ◽  
Normal Pressure ◽  
Reactivity Index ◽  
Outflow Resistance ◽  
Cardiovascular Comorbidity ◽  
Csf Circulation ◽  
Csf Diversion ◽  
The Relationship

AbstractIntroductionNormal pressure hydrocephalus (NPH) is not simply the result of a disturbance in cerebrospinal fluid (CSF) circulation, but often includes cardiovascular comorbidity and abnormalities within the cerebral mantle. In this study, we have examined the relationship between the global autoregulation pressure reactivity index (PRx), the profile of disturbed CSF circulation and pressure-volume compensation, and their possible effects on outcome after surgery.Materials and methodsWe studied a cohort of 131 patients, investigated for possible NPH. Parameters describing CSF compensation and circulation were calculated during the cerebrospinal fluid (CSF) infusion test and PRx was calculated from CSF pressure and arterial pressure recordings. A simple scale was used to mark the patients’ outcome 6 months after surgery (improvement, temporary improvement, and no improvement).ResultsPRx was negatively correlated with Rout (R=−0.18; p=0.044); patients with normal CSF circulation tended to have worse autoregulation. The correlation for patients who were surgically-managed (N=83) was: R=−0.28; p=0.03, and stronger in patients who improved after surgery (N=64; R=−0.36; p=0.03). In patients who did not improve, the correlation was not significantly different from zero (N= 19; R=0.17; p=0.15). There was a trend towards higher values for PRx in non-responders than in responders (PRx =0.16+/− 0.04 vs 0.09 +/−0.02 respectively; p=0.061), associated with higher MAP values (107.2+/−8.2 in non-responders vs 89.5+/−3.5 in responders; p=0.195). The product of MAP* (1+PRx), proposed as a measure of combined arterial hypertension and deranged autoregulation, showed a significant association with outcome (greater value in non-responders; p=0.013).ConclusionAutoregulation proves to associate with cerebrospinal fluid circulation, and appears strongest in shunt responders. Outcome following CSF diversion is possibly most favorable when CSF outflow resistance is increased and global cerebral autoregulation is intact, in combination with arterial normotension.

LONG-TERM OUTCOME IN PATIENTS WITH SUSPECTED NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 327-332 ◽  
Author(s):  
Babar Kahlon ◽  
Johan Sjunnesson ◽  
Stig Rehncrona
Keyword(s):  
Cerebrospinal Fluid ◽  
Reaction Time ◽  
Normal Pressure Hydrocephalus ◽  
Barthel Index ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Term Outcome ◽  
Long Term Outcome

Abstract OBJECTIVE To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt surgery. METHODS Seventy-five patients (mean age, 72.5 6 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 6 4.6 mo) and long-term (5.5 6 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index. RESULTS At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P &lt; 0.05) in improved patients. CONCLUSION Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.

Sign in / Sign up

Export Citation Format

Share Document