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Global Cerebral Autoregulation, Resistance to Cerebrospinal Fluid Outflow and Cerebrovascular Burden in Normal Pressure Hydrocephalus

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Intracranial Pressure and Neuromonitoring XVII

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 131))

Summary

Introduction: We previously examined the relationship between global autoregulation pressure reactivity index (PRx), mean arterial blood pressure (ABP), Resistance to cerebral spinal fluid (CSF) outflow (Rout) and their possible effects on outcome after surgery on 83 shunted patients. In this study, we aimed to quantify the relationship between all parameters that influence Rout, their interaction with the cerebral vasculature, and their role in shunt prognostication.

Methods: From 423 patients having undergone infusion tests for possible NPH, we selected those with monitored ABP and calculated its mean and PRx. After shunting, 6 months patients’ outcome was marked using a simple scale (improvement, temporary improvement, and no improvement). We explored the relationship between age, different CSF dynamics variables, and vascular parameters using multivariable models.

Results: Rout had a weaker predictive value than ABP (Fisher Discrimination Ratio of 0.02 versus 0.42). ABP > 98 was an independent predictor of shunt outcome with odd ratio 6.4, 95% CI: 1.8–23.4 and p-value = 0.004. There was a strong and significant relationship between the interaction of age, PRx, ABP, and Rout (R = 0.53 with p = 7.28 × 10−0.5). Using our linear model, we achieved an AUC 86.4% (95% CI: 80.5–92.3%) in detecting shunt respondents. The overall sensitivity was 94%, specificity 75%, positive predictive value (PPV) of 54%, and negative predictive value of 97%.

Conclusion: In patients with low Rout and high cerebrovascular burden, as described by high ABP and disturbed global autoregulation, response to shunting is less likely. The low PPV of high resistance, preserved autoregulation and absence of hypertension could merit further exploration.

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Authors and Affiliations

  1. Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK

    Afroditi D. Lalou, Matthew Garnett, Eva Nabbanja, Marek Czosnyka & Zofia H. Czosnyka

  2. Biomedical Engineering Department, California State University, Long Beach, CA, USA

    Shadnaz Asgari

Authors
  1. Afroditi D. Lalou
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  2. Shadnaz Asgari
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  3. Matthew Garnett
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  4. Eva Nabbanja
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  5. Marek Czosnyka
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  6. Zofia H. Czosnyka
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Corresponding author

Correspondence to Afroditi D. Lalou .

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Editors and Affiliations

  1. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium

    Bart Depreitere

  2. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Geert Meyfroidt

  3. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Fabian Güiza

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All other authors certify that they have no affiliations with any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

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Lalou, A.D., Asgari, S., Garnett, M., Nabbanja, E., Czosnyka, M., Czosnyka, Z.H. (2021). Global Cerebral Autoregulation, Resistance to Cerebrospinal Fluid Outflow and Cerebrovascular Burden in Normal Pressure Hydrocephalus. In: Depreitere, B., Meyfroidt, G., Güiza, F. (eds) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement, vol 131. Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_67

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  • DOI: https://doi.org/10.1007/978-3-030-59436-7_67

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-59435-0

  • Online ISBN: 978-3-030-59436-7

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