Is there a correlation between operative results and change in ventricular volume after shunt placement? A study of 60�cases of idiopathic normal-pressure hydrocephalus

2003 ◽  
Vol 45 (6) ◽  
pp. 377-380 ◽  
Author(s):  
U. Meier ◽  
S. Paris ◽  
A. Gr�we ◽  
D. Stockheim ◽  
A. Hajdukova ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Operative Results ◽  
Shunt Placement

scholarly journals Prevalence of Cervical Stenosis and Myelopathy in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan M Naylor ◽  
Karina Lenartowicz ◽  
Jonathan Graff-Radford ◽  
Jeremy Cutsforth-Gregory ◽  
Benjamin D Elder
Keyword(s):  
Cervical Spine ◽  
Normal Pressure Hydrocephalus ◽  
Cervical Myelopathy ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Decompression Surgery ◽  
Consecutive Series ◽  
Cervical Stenosis ◽  
Shunt Placement

Abstract INTRODUCTION Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. It is possible that some of the patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical stenosis with or without myelopathy in patients with iNPH. METHODS We screened a consecutive series of patients who underwent shunt placement for iNPH for comorbid cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis based on previously published criteria, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS A total of 42 patients with iNPH were included for analysis. Slightly more patients were male (65%), with a mean age of 75 yr (SD 7 yr) for the entire cohort. All patients presented with gait disturbances and underwent cervical spine MRI. 30/42 (71%) had at least cervical stenosis, while 7/42 (17%) had significant (grade 2-3) cervical stenosis with myelopathy requiring surgical decompression. All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSION Clinically significant cervical stenosis is highly prevalent in patients with iNPH, though this finding requires validation in a larger population. Based on these results, cervical imaging should be considered preoperatively or in patients whose gait does not improve after shunt placement.

scholarly journals Phase-contrast magnetic resonance imaging reveals net retrograde aqueductal flow in idiopathic normal pressure hydrocephalus

2016 ◽  
Vol 124 (6) ◽  
pp. 1850-1857 ◽  
Author(s):  
Geir Ringstad ◽  
Kyrre Eeg Emblem ◽  
Per Kristian Eide
Keyword(s):  
Flow Rate ◽  
Normal Pressure Hydrocephalus ◽  
Phase Contrast ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Conservative Group ◽  
Shunt Placement ◽  
Before And After ◽  
Shunt Group ◽  
Antegrade Flow

OBJECT The objective of this study was to assess the net aqueductal stroke volume (ASV) and CSF aqueductal flow rate derived from phase-contrast MRI (PC-MRI) in patients with probable idiopathic normal pressure hydrocephalus (iNPH) before and after ventriculoperitoneal shunt surgery, and to compare observations with intracranial pressure (ICP) scores. METHODS PC-MRI at the level of the sylvian aqueduct was undertaken in patients undergoing assessment for probable iNPH. Aqueductal flow in the craniocaudal direction was defined as positive, or antegrade flow, and net ASV was calculated by subtracting retrograde from antegrade aqueductal flow. Aqueductal flow rate per minute was calculated by multiplying net ASV by heart rate. During the same hospital admission, clinical examination was performed using NPH score and overnight continuous ICP monitoring. Twelve patients were followed prospectively 12 months after shunt placement with clinical assessment and a second PC-MRI. The study also included 2 healthy controls. RESULTS Among 21 patients examined for iNPH, 17 (81%) received a shunt (shunt group), and 4 were treated conservatively (conservative group). Among the patients with shunts, a clinical improvement was observed in 16 (94%) of the 17. Net ASV was negative in 16 (76%) of 21 patients before shunt placement and in 5 (42%) of 12 patients after shunt placement, and increased from a median of −5 μl (range −175 to 27 μl) to a median of 1 μl (range −61 to 30 μl; p = 0.04). Among the 12 patients with PC-MRI after shunt placement, 11 were shunt responders, and in 9 of these 11 either a reduced magnitude of retrograde aqueductal flow, or a complete reversal from retrograde to antegrade flow, occurred. Net ASV was significantly lower in the shunt group than in the conservative group (p = 0.01). The aqueductal flow rate increased from −0.56 ml/min (range −12.78 to 0.58 ml/min) to 0.06 ml/min (range −4.51 to 1.93 ml/min; p = 0.04) after shunt placement. CONCLUSIONS In this cohort of patients with iNPH, retrograde net aqueductal flow was observed in 16 (76%) of 21 patients. It was reversed toward the antegrade direction after shunt placement either by magnitude or completely in 9 (75%) of 12 patients examined using PC-MRI both before and after shunt placement (p = 0.04); 11 of the 12 were shunt responders. The study results question previously established concepts with respect to both CSF circulation pathways and CSF formation rate.

scholarly journals Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 582-593 ◽  
Author(s):  
Kathleen A. McConnell ◽  
Kelly H. Zou ◽  
Alexandra V. Chabrerie ◽  
Nancy Olsen Bailey ◽  
Peter McL. Black
Keyword(s):  
Correlation Coefficient ◽  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Adjustable Valve ◽  
Programmable Valve ◽  
Valve Pressure ◽  
Over Time

Abstract OBJECTIVE: This retrospective study examined whether changes in ventricular volume correspond with changes in adjustable valve pressure settings in a cohort of patients who received shunts to treat idiopathic normal pressure hydrocephalus. We also examined whether these pressure–volume curves and other patient variables would co-occur with a positive clinical response to shunting. METHODS: We selected 51 patients diagnosed with idiopathic normal pressure hydrocephalus who had undergone implantation of a Codman Hakim programmable valve (Medos S.A., Le Locle, Switzerland). Clinical data were gathered from the patients' records and clinical notes by an investigator blinded to patients' ventricular volumes. Ventricular volume was measured using 3D Slicer, an image analysis and interactive visualization software package developed and maintained at the Surgical Planning Laboratory at Brigham and Women's Hospital. RESULTS: Eighty-six percent of patients with gait disturbance at presentation showed improvement of this symptom, 70% experienced improvement in incontinence, and 69% experienced improvement in dementia. For the group showing 100% clinical improvement, the correlation coefficient of average changes in valve pressure over time (ΔP/ΔT) and average changes in ventricular volume over time (ΔV/ΔT) were high at 0.843 (P < 0.05). For the group experiencing no or only partial improvement, the correlation coefficient was 0.257 (P = 0.32), indicating no correlation between average ΔV/ΔT and average ΔP/ΔT for each patient. CONCLUSION: This was a carefully analyzed modeling study of idiopathic normal pressure hydrocephalus treatment made possible only by adjustable valve technology. With careful volumetric analysis, we found that changes in ventricular volume correlated with adjustments in valve pressure settings for those patients who improved clinically after shunting. This suggests that positive clinical responders retained parenchymal elasticity, emphasizing the importance of dynamic changes in this cohort.

Ventriculoperitoneal Shunting of Idiopathic Normal Pressure Hydrocephalus Increases Midbrain Size: A Potential Mechanism for Gait Improvement

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 847-851 ◽  
Author(s):  
J Mocco ◽  
Matthew I. Tomey ◽  
Ricardo J. Komotar ◽  
William J. Mack ◽  
Steven J. Frucht ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Medical Center ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Cross Sectional ◽  
Mean Values ◽  
Shunt Placement ◽  
Ventriculoperitoneal Shunting ◽  
The Mean

Abstract OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm2; postoperative mean, 6.90 ± 0.25 cm2; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

scholarly journals Postshunt Cognitive and Functional Improvement in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 416-419 ◽  
Author(s):  
Heather Katzen ◽  
Lisa D. Ravdin ◽  
Stephanie Assuras ◽  
Roberto Heros ◽  
Michael Kaplitt ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Repeated Measures ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Practice Effects ◽  
Control Group ◽  
Significant Group ◽  
Shunt Placement ◽  
Cognitive Improvement ◽  
Control Subjects

Abstract BACKGROUND: Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P < .003) and Symbol Digit Modalities (P < .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P < .001) and caregivers reported improved activities of daily living (P < .01) and reduced caregiver distress (P < .01). CONCLUSION: This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.

A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus

2009 ◽  
Vol 111 (3) ◽  
pp. 610-617 ◽  
Author(s):  
Chia-Cheng Chang ◽  
Hiroyuki Asada ◽  
Toshiro Mimura ◽  
Shinichi Suzuki
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Cerebrovascular Reactivity ◽  
Healthy Controls ◽  
Shunt Placement ◽  
Significant Difference ◽  
A Prospective Study

Object Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were investigated prospectively in 162 patients with a proposed diagnosis of idiopathic normal-pressure hydrocephalus (NPH). The aim of this study was to assess the usefulness of the measurement of CBF and CVR in determining which patients would be likely to benefit from shunt placement. Methods The mean CBF of the whole brain was measured according to the Patlak plot method by using technetium-99m hexamethylpropyleneamine oxime. The CVR value was obtained from the response to administration of 500 mg acetazolamide and calculated as the percentage change from the baseline mean CBF value. Results One hundred forty-six patients (90.1%) responded to shunt placement (“responders”), but 16 patients (9.9%) did not (“nonresponders”). No significant difference in preoperative CBF was observed between responders and nonresponders. Preoperative CVR was significantly impaired (p < 0.0025) in responders compared with healthy controls, but not in nonresponders. Responders with the incomplete triad had a significant reduction (p < 0.001) in preoperative CVR, but not in preoperative CBF, compared with healthy controls. Responders with the complete triad had significantly lower preoperative CBF and CVR than those with the incomplete triad (p < 0.01 and p < 0.05, respectively). Postoperative CBF and CVR increased significantly (p < 0.025 and p < 0.001, respectively) in responders. Conclusions Both CBF and CVR decrease with the development of NPH, suggesting that hemodynamic ischemia may be responsible for manifestation of the symptoms. Impaired CVR and reduced CBF with the development of symptoms can be proposed as diagnostic criteria for idiopathic NPH.

Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus

2004 ◽  
Vol 100 (6) ◽  
pp. 1036-1040 ◽  
Author(s):  
Ullrich Meier ◽  
Sven Mutze
Keyword(s):  
Clinical Outcome ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Communicating Hydrocephalus ◽  
Ventricular Size ◽  
Content Type ◽  
Shunt Placement ◽  
Postoperative Change ◽  
Fine Print

Object. It is well known that in patients with communicating hydrocephalus or normal-pressure hydrocephalus (NPH), ventricular size decreases following implantation of shunts with differential pressure valves. The aim of this study was to determine whether ventricular size correlates with a positive clinical outcome following shunt placement. Methods. Hydrostatic valves (dual-switch valves) were implanted in 80 patients with NPH at Unfallkrankenhaus, Berlin, between September 1997 and January 2002. One year postoperatively, these patients underwent computerized tomography scanning, and their ventricular size was ascertained using the Evans Index. Among 80% of the patients who showed no postoperative change in ventricular volume, 59% nonetheless had good to excellent clinical improvements, 17% satisfactory improvement, and 24% no improvement. Furthermore, a moderate reduction in ventricular size was observed in 14% of patients in this cohort. Among these, 36% experienced good to excellent clinical improvements, 28% satisfactory improvement, and 36% unsatisfactory improvement. A marked reduction in ventricular size was observed in 6% of the patients. Of this latter group, 60% demonstrated good to excellent outcomes, whereas 40% had unsatisfactory outcomes. Conclusions. Favorable outcomes following the implantation of a hydrostatic shunt in patients with NPH did not correlate with decreased ventricular volume 1 year after surgery. In fact, better clinical outcomes were observed in patients with little or no alteration in ventricular size, compared with those in patients with a marked decrease in ventricular size. A postoperative change in ventricular volume should be assessed differently in patients with NPH compared with those suffering from hypertensive hydrocephalus.

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