Alteration of brain viscoelasticity after shunt treatment in normal pressure hydrocephalus

2011 ◽  
Vol 54 (3) ◽  
pp. 189-196 ◽  
Author(s):  
Florian Baptist Freimann ◽  
Kaspar-Josche Streitberger ◽  
Dieter Klatt ◽  
Kui Lin ◽  
Joyce McLaughlin ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Shunt Treatment

scholarly journals Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

2020 ◽  
Vol 9 (4) ◽  
pp. 1084
Author(s):  
Tze-Wei Chang ◽  
Pao-Hui Tseng ◽  
Yi-Cheng Wang ◽  
Guo-Fang Tseng ◽  
Tsung-Lang Chiu ◽  
...  
Keyword(s):  
White Matter ◽  
Normal Pressure Hydrocephalus ◽  
Small Vessel Disease ◽  
Normal Pressure ◽  
Small Vessel ◽  
Karnofsky Performance Score ◽  
Vessel Disease ◽  
Lumboperitoneal Shunt ◽  
Shunt Treatment ◽  
Dopaminergic Degeneration

The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with 99mTc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) (p < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (p < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (p = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology.

NEUROPSYCHOLOGICAL EFFECTS OF SHUNT TREATMENT IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 527-536 ◽  
Author(s):  
Per Hellström ◽  
Mikael Edsbagge ◽  
Elisabeth Blomsterwall ◽  
Trevor Archer ◽  
Magnus Tisell ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Neuropsychological Tests ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Consecutive Series ◽  
Shunt Surgery ◽  
Healthy Individuals ◽  
Neuropsychological Effects ◽  
Wide Range ◽  
Shunt Treatment

ABSTRACT OBJECTIVE To prospectively evaluate the effects of shunting on the neuropsychological performance of patients with idiopathic normal pressure hydrocephalus (INPH), to compare their performance with that of healthy individuals, and to estimate the predictive utility of putatively important factors. METHODS A consecutive series of 47 patients with INPH underwent neurological, radiological, and neuropsychological examinations before and 3 months after shunt surgery. The same neuropsychological tests, measuring simple and target reaction times, dexterity, memory and learning, working memory, and aspects of executive functioning, were also administered to 159 healthy individuals. RESULTS Performance on all neuropsychological tests, except Simple Reaction Time and Digit Span, significantly improved after surgery, with more severe functional deficits showing greatest improvement. Age, education, duration, vascular comorbidity, sex, and onset symptom all failed to predict the neuropsychological effects of treatment. Despite improvement 3 months after shunt surgery, INPH patients were still outperformed by healthy individuals. CONCLUSION Most of the wide range of neuropsychological functions that are affected by INPH are markedly improved by shunt treatment, but not completely restored.

Brain tissue Aβ42 levels are linked to shunt response in idiopathic normal pressure hydrocephalus

2018 ◽  
Vol 130 (1) ◽  
pp. 121-129 ◽  
Author(s):  
Sami Abu Hamdeh ◽  
Johan Virhammar ◽  
Dag Sehlin ◽  
Irina Alafuzoff ◽  
Kristina Giuliana Cesarini ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Normal Pressure Hydrocephalus ◽  
Surgical Outcome ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Csf Biomarkers ◽  
Vp Shunt ◽  
Tissue Levels ◽  
Shunt Procedure ◽  
Shunt Treatment

OBJECTIVEThe authors conducted a study to test if the cortical brain tissue levels of soluble amyloid beta (Aβ) reflect the propensity of cortical Aβ aggregate formation and may be an additional factor predicting surgical outcome following idiopathic normal pressure hydrocephalus (iNPH) treatment.METHODSHighly selective ELISAs (enzyme-linked immunosorbent assays) were used to quantify soluble Aβ40, Aβ42, and neurotoxic Aβ oligomers/protofibrils, associated with Aβ aggregation, in cortical biopsy samples obtained in patients with iNPH (n = 20), sampled during ventriculoperitoneal (VP) shunt surgery. Patients underwent pre- and postoperative (3-month) clinical assessment with a modified iNPH scale. The preoperative CSF biomarkers and the levels of soluble and insoluble Aβ species in cortical biopsy samples were analyzed for their association with a favorable outcome following the VP shunt procedure, defined as a ≥ 5-point increase in the iNPH scale.RESULTSThe brain tissue levels of Aβ42 were negatively correlated with CSF Aβ42 (Spearman’s r = −0.53, p < 0.05). The Aβ40, Aβ42, and Aβ oligomer/protofibril levels in cortical biopsy samples were higher in patients with insoluble cortical Aβ aggregates (p < 0.05). The preoperative CSF Aβ42 levels were similar in patients responding (n = 11) and not responding (n = 9) to VP shunt treatment at 3 months postsurgery. In contrast, the presence of cortical Aβ aggregates and high brain tissue Aβ42 levels were associated with a poor outcome following VP shunt treatment (p < 0.05).CONCLUSIONSBrain tissue measurements of soluble Aβ species are feasible. Since high Aβ42 levels in cortical biopsy samples obtained in patients with iNPH indicated a poor surgical outcome, tissue levels of Aβ species may be associated with the clinical response to shunt treatment.

Outcome of Shunting in Idiopathic Normal-pressure Hydrocephalus and the Value of Outcome Assessment in Shunted Patients

Neurosurgery ◽  
2005 ◽  
Vol 57 (suppl_3) ◽  
pp. S2-40-S2-52 ◽  
Author(s):  
Petra Klinge ◽  
Anthony Marmarou ◽  
Marvin Bergsneider ◽  
Norman Relkin ◽  
Peter McL. Black
Keyword(s):  
Outcome Assessment ◽  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Long Term Results ◽  
Shunt Treatment ◽  
Criteria For Selection

Abstract OBJECTIVE: To develop guidelines for assessing shunt outcome in patients with idiopathic normal-pressure hydrocephalus (INPH). To date, the literature available on this topic has been marked by disparate definitions of clinical improvement, varying postoperative follow-up protocols and periods, and substantial differences in the postoperative management. Because specific criteria for defining clinical improvement are seldom reported, conclusions drawn about shunt outcome may be subjective. METHODS: A MEDLINE search back to 1966 was undertaken using the query NPH, normal-pressure hydrocephalus, shunting, shunt treatment, shunt response, outcome, and clinical outcome. The criteria for selection were studies that included INPH from 1966 to the present in which the outcome of INPH was reported in patient groups of 20 or more. RESULTS: To date, there is no standard for outcome assessment of shunt treatment in INPH. The variable improvement rates reported are not only because of different criteria for selection of patients but also because of different postoperative assessment procedures and follow-up intervals. CONCLUSION: Studies that have established fixed protocols for follow-up have shown that short- and long-term periods after shunting are determined by many factors. Whereas short-term results were more likely to be influenced by shunt-associated risks, long-term results were independent of factors inherent to the shunt procedure and shunt complications, i.e., death and morbidity related to concomitant cerebrovascular and vascular diseases. Studies have shown that beyond 1 year after surgery, these factors definitely influence the clinical effect of shunting, making the 1-year postshunt period a potential determinant of the shunt outcome. Guidelines for outcome assessment were developed on the basis of the available evidence and consensus of expert opinion.

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