Abstract
Background
Late-onset idiopathic aqueductal stenosis may present with clinical features indistinct from idiopathic normal-pressure hydrocephalus (NPH). Moreover, aqueductal stenosis (AS) is not always detected by conventional magnetic resonance imaging (MRI). The aim of this study was to compare the hydrodynamic pattern among NPH patients according to the patency of the aqueduct.
Methods
Fifty-six consecutive lumbar infusion tests were performed in patients with NPH syndrome. Precipitating causes of hydrocephalus were excluded, and aqueductal patency was examined through high-resolution, T2-weighted 3D MRI. Patients were classified into two groups: non-patent aqueduct and patent aqueduct. Mean values of pressure and pulse amplitude were obtained from basal and plateau stages of infusion studies.
Results
Twelve of 56 patients with NPH-like symptoms presented with morphological AS (21.4 %). Patent aqueduct and non-patent aqueduct groups had similar values of mean opening lumbar pressure (8.2 vs. 8.1 mmHg), and mean opening pulse amplitude (3.1 vs. 2.9 mmHg). Mean pressure in the plateau stage (28.6 vs. 23.2 mmHg), and mean pulse amplitude in the plateau stage (12.5 vs. 10.6 mmHg) were higher in the patent aqueduct group. These differences were not statistically significant. Only Rout was significantly higher in the patent aqueduct group (13.6 vs. 10.1 mmHg/ml/min). One-third of NPH patients with AS presented Rout >12 mmHg/ml/min.
Conclusions
No differences in mean pressure or pulse amplitude during basal and plateau epochs of the lumbar infusion test in NPH patients were detected, regardless of aqueductal patency. However, Rout was significantly higher in patients with patent aqueduct.
Similar content being viewed by others
References
Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 273:117–126
Albeck MJ, Borgesen SE, Gjerris F, Schmidt JF, Sorensen PS (1991) Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg 74:597–600
Albeck MJ, Skak C, Nielsen PR, Olsen KS, Borgesen SE, Gjerris F (1998) Age dependency of resistance to cerebrospinal fluid outflow. J Neurosurg 89:275–278
Algin O, Hakyemez B, Parlak M (2010) Phase-contrast MRI and 3D-CISS versus contrast-enhanced MR cisternography on the evaluation of the aqueductal stenosis. Neuroradiology 52:99–108
Bateman GA (2007) Magnetic resonance imaging quantification of compliance and collateral flow in late-onset idiopathic aqueductal stenosis: venous pathophysiology revisited. J Neurosurg 107:951–958
Bateman GA (2008) The pathophysiology of idiopathic normal pressure hydrocephalus: cerebral ischemia or altered venous hemodynamics? Am J Neuroradiol 29(1):198–203
Bech-Azeddine R, Bogeskov L, Borgesen S, Juhler M (1999) Indications for shunt insertion or III ventriculostomy in hydrocephalic children, guided by lumbar and intraventricular infusion tests. Childs Nerv Syst 15:213–218
Bech-Azeddine R, Nielsen OA, Logager VB, Juhler M (2007) Lumbar elastance and resistance to CSF outflow correlated to patency of the cranial subarachnoid space and clinical outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 50:189–194
Bering EA, Ingraham FD (1953) The arterial pulsation of the cerebrospinal fluid; its origin, configuration and possible clinical importance. Trans Am Neurol Assoc 3:49–52
Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87:687–693
Czosnyka M, Czosnyka Z, Agarwal-Harding KJ, Pickard JD (2012) Modeling of CSF dynamics: legacy of Professor Anthony Marmarou. Acta Neurochir (Wien) Suppl 113:9–14
Dandy W, Blackfan K (1913) An experimental and clinical study of internal hydrocephalys. JAMA 61:2216–2217
Delwel EJ, de Jong DA, Avezaat CJ (2005) The prognostic value of clinical characteristics and parameters of cerebrospinal fluid hydrodynamics in shunting for idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 147(10):1037–1042
Di Rocco C, Pettorossi VE, Caldarelli M, Mancinelli R, Velardi F (1978) Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pressure: experimental studies. Exp Neurol 59:40–52
Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303
Eide PK, Brean A (2010) Cerebrospinal fluid pulse pressure amplitude during lumbar infusion in idiopathic normal pressure hydrocephalus can predict response to shunting. Cerebrospinal Fluid Res 7:5
Eide PK, Sorteberg W (2010) Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients. Neurosurgery 66:80–91
Eklund A, Smielewski P, Chambers I, Alperin N, Malm J, Czosnyka M, Marmarou A (2007) Assessment of cerebrospinal fluid outflow resistance. Med Bio Eng Comput 45:719–735
Fukuhara T, Luciano MG (2001) Clinical features of late-onset idiopathic aqueductal stenosis. Surg Neurol 55:132–136
Hashimoto M, Ishikawa M, Mori E, Kuwana N, Study of Ioni (2010) Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res 7:18
Katzman R, Hussey F (1970) A simple constant-infusion manometric test for measurement of CSF absorption. I Rationale Method Neurol 20:534–544
Malm J, Jacobsson J, Birgander R, Eklund A (2011) Reference values for CSF outflow resistance and intracranial pressure in healthy elderly. Neurology 76:903–909
Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM (2005) The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S17–28
Meier U, Zellinger S, Schönherr B (2000) Endoscopic ventriculostomy versus shunt operation in normal pressure hydrocephalus: diagnostics and indication. Acta Neurochir (Wien) 76:563–566
Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S4–16
Stephensen H, Tisell M, Wikkelso C (2002) There is no transmantle pressure gradient in communicating or noncommunicating hydrocephalus. Neurosurgery 50:763–771
Tans JT, Poortvliet DC (1984) Comparison of ventricular steady-state infusion with bolus infusion and pressure recording for differentiating between arrested and non-arrested hydrocephalus. Acta Neurochir (Wien) 72:15–29
Tisell M, Edsbagge M, Stephensen H, Czosnyka M, Wikkelso C (2002) Elastance correlates with outcome after endoscopic third ventriculostomy in adults with hydrocephalus caused by primary aqueductal stenosis. Neurosurgery 50(1):70–77
Tisell M, Tullberg M, Mansson JE, Fredman P, Blennow K, Wikkelso C (2004) Differences in cerebrospinal fluid dynamics do not affect the levels of biochemical markers in ventricular CSF from patients with aqueductal stenosis and idiopathic normal pressure hydrocephalus. Eur J Neurol 11:17–23
Tisell M, Tullberg M, Hellström P, Blomsterwall E, Wikkelsø C (2003) Neurological symptoms and signs in adult aqueductal stenosis. Acta Neurol Scand 107:311–317
Tisell M (2005) How should primary aqueductal stenosis in adults be treated? Acta Neurol Scand 111:145–153
Vanneste J, Augustijn P, Tan WF, Dirven C (1993) Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry 56:251–256
Vanneste J (1994) Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry 57(9):1021–1025
Wagshul ME, Eide PK, Madsen JR (2011) The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 8:5
Wikkelsø C, Hellström P, Klinge PM, Tans JT, European iNPH Multicentre Study Group (2013) 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 84(5):562–568
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this research.
Conflict 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 University Hospital of León (Spain), and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
González-Martínez, E.L., Santamarta, D. Does aqueductal stenosis influence the lumbar infusion test in normal-pressure hydrocephalus?. Acta Neurochir 158, 2305–2310 (2016). https://doi.org/10.1007/s00701-016-2975-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-016-2975-1