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Anterior callosal angle correlates with gait impairment and fall risk in iNPH patients

  • Original Article - Neurosurgery general
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Abstract

Background

In idiopathic normal pressure hydrocephalus (iNPH), gait and balance impairment is the most frequent symptom, and it is often associated with a higher fall risk. In a prior study, the anterior callosal angle (ACA) was validated as a reliable marker to discriminate iNPH from Alzheimer’s disease and healthy controls. However, the potential correlation between the ACA with clinical symptoms and functional outcomes has not been assessed. The objective of this study is to determine the utility of the ACA in predicting gait improvement after ventriculoperitoneal (VP) shunting.

Methods

Patients with probable iNPH who underwent shunt placement at a single institution were prospectively enrolled from May 2015 to May 2019. Patients were assessed preoperatively and at 6 months postoperatively following a standard clinical and MRI protocol. Callosal angle (CA) and ACA were calculated from 3 T MRI preoperatively and at 6 months postoperatively. CA and ACA were tested for correlation with clinical scores.

Results

Forty-seven patients with probable INPH who completed 6-month postoperative follow-up were enrolled in the study. Baseline ACA was significantly correlated with preoperative fall risk, gait, and balance impairment assessed with Tinetti POMA scale. Additionally, baseline ACA differentiated patients who experienced improvement at Tinetti POMA scale after surgery.

Conclusions

The baseline ACA is a useful neuroradiological marker to differentiate patients by fall risk and has significant correlation with the improvement in gait and balance impairment following surgery. This study demonstrated that the ACA may be a complementary tool to the CA in predicting shunt responsiveness in iNPH.

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Acknowledgments

PRO-HYDRO Study Group: Raffaele Agati1, Raffaele Aspide1, Giovanna Calandra-Buonaura1,2, Sabina Capellari1,2, Lorenzo Chiari3, Alberto Ferrari3, Elena Magelli1, Margherita Merola1, Federico Oppi1, Piero Parchi1,4, Alessandro Pirina1, Vito Antonio Piserchia1, Luisa Sambati1.

1IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italia.

2DIBINEM, University of Bologna, Bologna, Italy.

3CIRI-SDV, University of Bologna, Bologna, Italy.

4DIMES, University of Bologna, Bologna, Italy.

Author information

Author notes

  1. Paolo Mantovani

    Present address: IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy

Authors and Affiliations

  1. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy

    Carmelo Sturiale & Giorgio Palandri

  2. Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Giulia Giannini & Sabina Cevoli

  3. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy

    Giulia Giannini, Nicola Valsecchi, Laura Ludovica Gramegna & Pietro Cortelli

  4. UOSI Medicina Riabilitativa Intensiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    David Milletti

  5. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy

    Laura Ludovica Gramegna & Luca Albini-Riccioli

  6. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Giuseppe Lanzino & Benjamin D. Elder

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  1. Paolo Mantovani
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  2. Giulia Giannini
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Consortia

PRO-HYDRO Study Group

  • Raffaele Agati
  • , Raffaele Aspide
  • , Giovanna Calandra-Buonaura
  • , Sabina Capellari
  • , Lorenzo Chiari
  • , Alberto Ferrari
  • , Elena Magelli
  • , Margherita Merola
  • , Federico Oppi
  • , Piero Parchi
  • , Alessandro Pirina
  • , Vito Antonio Piserchia
  •  & Luisa Sambati

Corresponding author

Correspondence to Paolo Mantovani.

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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.

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

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Mantovani, P., Giannini, G., Milletti, D. et al. Anterior callosal angle correlates with gait impairment and fall risk in iNPH patients. Acta Neurochir 163, 759–766 (2021). https://doi.org/10.1007/s00701-020-04699-7

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  • DOI: https://doi.org/10.1007/s00701-020-04699-7

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