Abstract
Background: Intracranial pressure (ICP) monitoring and infusion studies have long been used in the preoperative workup of patients with suspected idiopathic normal-pressure hydrocephalus (iNPH). We have analysed the predictive values of different measures derived from both investigations, emphasising the differences between responders and nonresponders. Materials and methods: ICP monitoring and lumbar infusion studies were routinely performed during a 6-year period. Shunting was proposed when the resistance to cerebrospinal fluid outflow (ROUT) >12 mmHg/ml/min and/or a minimum 15 % of slow waves were detected. The outcome was evaluated 6 months after surgery. Recorded data from ICP monitoring were mean pressure and pulse amplitude, the total percentage of slow waves and the presence of different types of slow waves following the classification proposed by Raftopoulos et al. Recorded data from lumbar infusion studies were mean values of pressure and pulse amplitude during three epochs (basal, early infusion and plateau), ROUT and the pulsatility response to the increase in mean pressure during the infusion. This response was quantified by two pulse amplitude indexes: the pulse amplitude index during the early infusion stage (A1) and the pulse amplitude index during the plateau stage (A2). Results: Thirty shunted patients were evaluated at the end of the follow-up and 23 (76.7 %) of them improved. Differences in the percentage of slow waves, ROUT and both pulsatility indexes were not statistically significant. The proportion of patients with great symmetrical waves and pulse amplitude during the early infusion stage were higher in responders (p < 0.05). The predictive analysis yielded the highest accuracy, with ROUT and A1 as a logical “OR” combination. Conclusion: The combined use of ICP monitoring and lumbar infusion to forecast the response to shunting in patients with suspected iNPH did not improve the accuracy provided by any of them alone.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Anile C, De Bonis P, Albanese A, Di Chirico A, Mangiola A, Petrella G, Santini P (2010) Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience. J Neurosurg 113:64–73
Bárcena A, Mestre C, Cañizal JM, Rivero B, Lobato RD (1997) Idiopathic normal pressure hydrocephalus: analysis of factors related to cerebrospinal fluid dynamics determining functional prognosis. Acta Neurochir 139:933–941
Belloni G, di Rocco C, Focacci C, Galli G, Maira G, Rossi GF (1976) Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of the surgical treatment. Acta Neurochir 33:1–21
Bering EA Jr (1962) Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement. J Neurosurg 19:405–413
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
Borgesen SE, Gjerris F (1982) The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 105:65–86
Brean A, Eide PK (2008) Assessment of idiopathic normal pressure patients in neurological practice: the role of lumbar infusion testing for referral of patients to neurosurgery. Eur J Neurol 15:605–612
Czosnyka Z, Keong N, Kim DJ, Radolovich D, Smielevski P, Lavinio A, Schmidt EA, Momjian S, Owler B, Pickard JD, Czosnyka M (2008) Pulse amplitude of intracranial pressure waveform in hydrocephalus. Acta Neurochir Suppl 102:137–140
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) 147:1037–1042
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
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
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. doi:10.1186/1743-8454-7-5 [pii]
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
Foltz EL, Aine C (1981) Diagnosis of hydrocephalus by CSF pulse-wave analysis: a clinical study. Surg Neurol 15:283–293
Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:307–327
Janny P (1950) La pression intra-crânniene chez l’homme. Méthode d’enregistrement – Etude de ses variations et de ses rapports avec les signes cliniques et oftlamologiques. Thesis, Paris
Janny P, Colnet G, Veyre A, Chazal J, Barreto LC (1981) Hydrocéphalie a pression normale. Etude pré- and postoperatoire de 56 cas. Neurochirurgie 27:89–96
Kahlon B, Sundbarg G, Rehncrona S (2002) Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 73:721–726
Katzman R, Hussey F (1970) A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 20:534–544
Krauss JK, Droste DW, Bohus M, Regel JP, Scheremet R, Riemann D, Seeger W (1995) The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus. Acta Neurochir 136:195–203
Krauss JK, Halve B (2004) Normal pressure hydrocephalus: survey of contemporary algorithms and therapeutic decision-making in clinical practice. Acta Neurochir 146:379–388
Lamas E, Lobato RD (1979) Intraventricular pressure and CSF dynamics in chronic adult hydrocephalus. Surg Neurol 12:287–295
Lemaire JJ, Chazal J, Gutknecht JL, Picard P, Irthum B, Boire JY (1994) Effects of acute compliance fluctuation on slow ICP waves: frequential aspects. In: Nagai H, Kamiya K, Ishii S (eds) Intracranial pressure IX. Springer, Berlin/Heidelberg/New York/Tokyo, pp 184–188
Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36:1–193
Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J (1995) The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Arch Neurol 52:783–789
Malm J, Eklund A (2006) Idiopathic normal pressure hydrocephalus. Pract Neurol 6:14–27
Marmarou A, Young HF, Aygok GA, Sawauchi S, Tsuji O, Yamamoto T, Dunbar J (2005) Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J Neurosurg 102:987–997
Pickard JD, Matheson M (1980) Intraventricular pressure waves – the best predictive test for shunting in normal pressure hydrocephalus. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Brock M (eds) Intracranial pressure IV. Springer, Berlin/Heidelberg/New York, pp 498–500
Poca MA, Mataro M, Matarin M, Arikan F, Junque C, Sahuquillo J (2004) Is the placement of shunts in patients with idiopathic normal-pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure. J Neurosurg 100:855–866
Qvarlander S, Lundkvist B, Koskinen L-OD, Malm J, Eklund A (2013) Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84:735–741
Raftopoulos C, Chaskis C, Delecluse F, Cantraine F, Bidaut L, Brotchi J (1992) Morphological quantitative analysis of intracranial pressure waves in normal pressure hydrocephalus. Neurol Res 14:389–396
Reh DD, Gallia GL, Ramanathan M, Solomon D, Moghekar A, Ishii M, Lane AP (2010) Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks: presentation of a novel technique. Am J Rhinol Allergy 24:238–243
Sahuquillo J, Rubio E, Codina A, Molins A, Guitart JM, Poca MA, Chasampi A (1991) Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called “normal pressure hydrocephalus” syndrome. Acta Neurochir (Wien) 112:50–61
Symon L, Dorsch NW (1975) Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery. J Neurosurg 42:258–273
Woodworth GF, McGirt MJ, Williams MA, Rigamonti D (2009) Cerebrospinal fluid drainage and dynamics in the diagnosis of normal pressure hydrocephalus. Neurosurgery 64:919–926
Acknowledgement
We gratefully acknowledge the assistance of Teresa Ek in correcting the manuscript.
Conflict of Interest Statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Santamarta, D., González-Martínez, E., Fernández, J., Mostaza, A. (2016). The Prediction of Shunt Response in Idiopathic Normal-Pressure Hydrocephalus Based on Intracranial Pressure Monitoring and Lumbar Infusion. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_53
Download citation
DOI: https://doi.org/10.1007/978-3-319-22533-3_53
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22532-6
Online ISBN: 978-3-319-22533-3
eBook Packages: MedicineMedicine (R0)