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Acta Neurochirurgica

, Volume 159, Issue 1, pp 51–61 | Cite as

Associations of intracranial pressure with brain biopsy, radiological findings, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus

  • Maria Kojoukhova
  • Krista-Irina Vanha
  • Matti Timonen
  • Anne M. Koivisto
  • Ossi Nerg
  • Jaana Rummukainen
  • Tuomas Rauramaa
  • Ritva Vanninen
  • Juha E. Jääskeläinen
  • Anna Sutela
  • Ville Leinonen
Clinical Article - Neurosurgical Anatomy

Abstract

Background

It remains unclear how intracranial pressure (ICP) measures are associated with brain biopsies and radiological markers. Here, we aim to investigate associations between ICP and radiological findings, brain biopsies, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus (iNPH).

Method

In this study, we retrospectively analyzed data from 73 patients admitted with suspected iNPH to Kuopio University Hospital. Of these patients, 71% underwent shunt surgery. The NPH registry included data on clinical and radiological examinations, 24-h intraventricular pressure monitoring, and frontal cortical biopsy.

Results

The mean ICP and mean ICP pulse wave amplitude were not associated with the shunt response. Aggregations of Alzheimer’s disease (AD)-related proteins (amyloid-β, hyperphosphorylated tau) in frontal cortical biopsies were associated with a poor shunt response (P = 0.014). High mean ICP was associated with Evans’ index (EI; P = 0.025), disproportional sylvian and suprasylvian subarachnoid spaces (P = 0.014), and focally dilated sulci (P = 0.047). Interestingly, a high pulse wave amplitude was associated with AD-related biopsy findings (P = 0.032), but the mean ICP was not associated with the brain biopsy. The ICP was not associated with medial temporal lobe atrophy, temporal horn widths, or white matter changes. ICP B waves were associated with less atrophy of the medial temporal lobe (P = 0.018) and more severe disproportionality between the sylvian and suprasylvian subarachnoid spaces (P = 0.001).

Conclusions

The EI and disproportional sylvian and suprasylvian subarachnoid spaces were associated with mean ICP. Disproportionality was also associated with ICP B waves. These associations, although rather weak, with elevated ICP in 24-h measurements, support their value in iNPH diagnostics and suggest that these radiological markers are potentially related to the pathogenesis of iNPH. Interestingly, our results suggested that elevated pulse wave amplitude might be associated with brain amyloid accumulation.

Keywords

Idiopathic normal pressure hydrocephalus Intracranial pressure Shunt Brain biopsy Alzheimer’s disease Radiology 

Abbreviations

Amyloid beta

AD

Alzheimer’s disease

CSF

Cerebrospinal fluid

CT

Computed tomography

EI

Evans’ index

HPτ

Hyperphosphorylated tau

ICP

Intracranial pressure

iNPH

Idiopathic normal pressure hydrocephalus

KUH

Kuopio University Hospital

MMSE

Mini-Mental State Examination

MRI

Magnetic resonance imaging

NPH

Normal pressure hydrocephalus

SA

Subarachnoid

Notes

Acknowledgments

The authors thank Marita Voutilainen, RN, for maintenance of the KUH NPH register and biostatistician Tuomas Selander for statistical assistance.

Compliance with ethical standards

Funding

The Fund of Mauri and Sirkka Wiljasalo, KUH VTR Fund, and The Finnish Medical Foundation provided financial support in the form of grant funding. The sponsors had no role in the design or conduct of this research.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Maria Kojoukhova
    • 1
  • Krista-Irina Vanha
    • 1
  • Matti Timonen
    • 1
  • Anne M. Koivisto
    • 2
    • 3
  • Ossi Nerg
    • 2
    • 3
  • Jaana Rummukainen
    • 4
  • Tuomas Rauramaa
    • 4
    • 5
  • Ritva Vanninen
    • 6
  • Juha E. Jääskeläinen
    • 1
  • Anna Sutela
    • 6
  • Ville Leinonen
    • 1
  1. 1.Neurosurgery of NeuroCenterKuopio University Hospital and University of Eastern FinlandKuopioFinland
  2. 2.Unit of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
  3. 3.Neurology of NeuroCenterKuopio University HospitalKuopioFinland
  4. 4.Department of PathologyKuopio University HospitalKuopioFinland
  5. 5.Institute of Clinical Medicine-PathologyUniversity of Eastern FinlandKuopioFinland
  6. 6.Department of RadiologyKuopio University Hospital and University of Eastern FinlandKuopioFinland

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