Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is an often-overlooked or misdiagnosed brain disorder characterized by overt ventriculomegaly and associated with gait disturbances, cognitive impairment, and urinary incontinence. If correctly diagnosed, it is considered the only form of dementia treatable with surgery, namely through a ventriculoperitoneal or ventriculoatrial shunt with programmable valves.
Among the 856 spinal and ventricular infusion tests performed from 2001 to 2017 at our institution, we analyzed 106 cases selected for suspected normotensive hydrocephalus. In all cases, Intracranial Elastance Index (IEI) and outflow resistance (Rout) values were calculated: 52 of these patients underwent Spinal Katzman Test (SKT), and the remaining 54 underwent an intraventricular infusion test (IVKT). Of the 40 patients in the SKT group with pathological elastance (71%), 17 also had a Rout >12 mmHg and 23 a Rout <12 mmHg. Of the 50 patients in the IVKT group with pathological elastance (92%), 38 also had a Rout >12 mmHg and 12 a Rout <12 mmHg.
IVKT and SKT to date represent two useful tools in the diagnosis of normal pressure hydrocephalus. Despite being more invasive, IVKT, including both the intracranial elastance index (IEI) and Rout analysis, could be considered more reliable than SKT and therefore could be reserved for the most controversial cases.
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References
Andersson J, Rosell M, Kockum K, Söderström L, Laurell K. Challenges in diagnosing normal pressure hydrocephalus: evaluation of the diagnostic guidelines. eNeurologicalSci. 2017;7:27–31.
Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD. Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response. Published online: 9. 2015.
Hellström P, Klinge P, Tans J, Wikkelsø C. The neuropsychology of iNPH: findings and evaluation of tests in the European multicentre study. Clin Neurol Neurosurg. 2012;114(2):130–4. https://doi.org/10.1016/j.clineuro.2011.09.014.
Raneri F, Zella MAS, Di Cristofori A, Zarino B, Pluderi M, Spagnoli D. Supplementary tests in idiopathic Normal pressure hydrocephalus: a single-center experience with a combined lumbar infusion test and tap test. World Neurosurg. 2017;100:567–74.
Wikkelsø C, Hellström P, Klinge PM, Tans JTJ. European iNPH multicentre study group. The European iNPH multicentre study on the predictive values of resistance to CSF outflow and the CSF tap test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2013;84(5):562–8.
Mattoli MV, Treglia G, Calcagni ML, Mangiola A, Anile C, Trevisi G. Usefulness of brain positron emission tomography with different tracers in the evaluation of patients with idiopathic normal pressure hydrocephalous. Int J Mol Sci. 2020;21(18):6523.
Hussey F, Schanzer B, Katzman R. A simple constant-infusion manometric test for measurement of CSF absorption. II Clinical studies. Neurology. 1970;20(7):665–80.
Katzman R, Hussey F. A simple constant-infusion manometric test for measurement of CSF absorption. Rationale and method. Neurology. 1970;20(6):534–44.
Kahlon B. Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2002;73(6):721–6. https://doi.org/10.1136/jnnp.73.6.721.
Anile C, De Bonis P, Albanese A, Di Chirico A, Mangiola A, Petrella G, Santini P. Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience. J Neurosurg. 2010;113:64–73.
Trevisi G, Signorelli F, de Waure C, Stifano V, Sturdà C, Rapisarda A, Pompucci A, Mangiola A, Anile C. Intraventricular infusion test accuracy in predicting short- and long-term outcome of iNPH patients: a 10-year update of a three-decade experience at a single institution. Neurosurg Rev. 2021;44(6):3323–34.
Nucci CG, De Bonis P, Mangiola A, Santini P, Sciandrone M, Risi A, Anile C. Intracranial pressure wave morphological classification: automated analysis and clinical validation. Acta Neurochir. 2016;158:581–8.
Trevisi G, Frassanito P, Di Rocco C. Idiopathic cerebrospinal fluid overproduction: case-based review of the pathophysiological mechanism implied in the cerebrospinal fluid production. Croat Med J. 2014;55(4):377–87.
Giordan E, Palandri G, Lanzino G, Murad MH, Elder BD. Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. J Neurosurg. 2018:1–13.
Junkkari A, Luikku AJ, Danner N, Jyrkkänen HK, Rauramaa T, Korhonen VE, Koivisto AM, Nerg O, Kojoukhova M, Huttunen TJ, Jääskeläinen JE, Leinonen V. The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients. Fluids Barriers CNS. 2019;16:21.
Czosnyka Z, Owler B, Keong N, Santarius T, Baledent O, Pickard JD, Czosnyka M. Impact of duration of symptoms on CSF dynamics in idiopathic normal pressure hydrocephalus: duration of symptoms and CSF dynamics. Acta Neurol Scand. 2011;123:414–8. https://doi.org/10.1111/j.1600-0404.2010.01420.x.
Eide PK. The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing. J Neurosurg. 2016;125:1493–503. https://doi.org/10.3171/2015.11.JNS151529.
Eide PK, Sorteberg W. Outcome of surgery for idiopathic Normal pressure hydrocephalus: role of preoperative static and pulsatile intracranial pressure. World Neurosurg. 2016;86:186–193.e1. https://doi.org/10.1016/j.wneu.2015.09.067.
Bech-Azeddine R, Gjerris F, Waldemar G, Czosnyka M, Juhler M. Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochir. 2005;147(10):1027–35. discussion 1035-6.
Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD, Gronseth G, Gloss D. Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response: report of the guideline development, dissemination, and implementation subcommittee of the american academy of neurology. Neurology. 2015;85(23):2063–71. https://doi.org/10.1212/WNL.0000000000002193. Erratum in: Neurology. 2016 Feb 23;86(8):793. PMID: 26644048; PMCID: PMC4676757.
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Signorelli, F., Trevisi, G., Visocchi, M., Anile, C. (2023). Comparison Between Ventricular and Spinal Infusion Tests in Suspected Normal Pressure Hydrocephalus. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_34
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