Summary
Background. Although the mean intracranial pressure (ICP) is normal in patients with idiopathic normal pressure hydrocephalus (iNPH), there could possibly be alterations in their single ICP waves.
Method. Thirty-nine consecutive patients treated for iNPH with ventriculo-peritoneal shunts were followed prospectively with regard to clinical and radiological findings. Changes in clinical state 12 months after shunt surgery were assessed as change on a 15-3 score NPH Grading Scale, while the changes in ventricular size were assessed by linear measures. The ICP recordings were performed as part of routine pre-operative assessment, stored as raw data files, and analyzed retrospectively. The mean ICP as well as single ICP wave amplitudes were computed and analysed in consecutive 6 second time windows.
Findings. Twelve months after shunt surgery, changes in NPH score of 5 or more (very significant improvement) were observed in 12 patients (31%), of 3 to 4 (significant improvement) in 6 patients (15%), of 1 to 2 (slight improvement) in 9 patients (23%) and of −4 to 0 (non-responders) in 12 patients (31%). The ventricular size did not change in any of the outcome categories. While the pre-operative mean ICP was similar between outcome groups, the mean ICP wave amplitude was significantly higher in patients improving clinically as compared to the non-responders.
Conclusions. While pre-operative mean ICP was similar, the mean ICP wave amplitudes were significantly higher in iNPH patients improving clinically after shunt treatment as compared to the non-responders.
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References
RD Adams CM Fisher S Hakim RG Ojeman WH Sweet (1965) ArticleTitleSymptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 273 117–126 Occurrence Handle14303656 Occurrence Handle1:STN:280:DyaF2M7gvVarsA%3D%3D Occurrence Handle10.1056/NEJM196507152730301
Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London
Avezaat CJJ, vanEijndhoven JHM, deJong DA, Moolenaar WCJ (1976) A new method of monitoring intracranial volume-pressure relationship. In: Becks JWF, Bosch DA, Brock M (eds) Intracranial pressure, vol III, Springer Berlin Heidelberg New York Tokyo, pp 308–313
CJJ Avezaat JHM van Eijndhoven DJ Wyper (1979) ArticleTitleCerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry 42 687–700 Occurrence Handle490174 Occurrence Handle1:STN:280:DyaL3c%2FivVOrtw%3D%3D
A Barcena C Mestre JM Canizal B Rivero RD Lobato (1997) ArticleTitleIdiopathic normal pressure hydrocephalus: Analysis of factors related to cerebrospinal fluid dynamics determining functional prognosis. Acta Neurochir (Wien) 139 933–941 Occurrence Handle1:STN:280:DyaK1c%2FmsFWktw%3D%3D
AJW Boon JTJ Tans EJ Delwel SM Egeler-Peerdeman PW Hanlo HAL Wurzer CJJ Avezaat DA deJong RHJM Gooskens J Hermans (1997) ArticleTitleDutch normal-pressure hydrocephalus study: Prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87 687–693 Occurrence Handle9347976 Occurrence Handle1:STN:280:DyaK1c%2Fgs1Wquw%3D%3D
AJW Boon JTJ Tans EJ Delwel SM Egeler-Peerdeman PW Hanlo HAL Wurzer J Hermans (1999) ArticleTitleDutch normal-pressure hydrocephalus study: The role of cerebrovascular disease. J Neurosurg 90 221–226 Occurrence Handle9950492 Occurrence Handle1:STN:280:DyaK1M7jtl2qsw%3D%3D
M Chopp HD Portnoy (1980) ArticleTitleSystems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis. J Neurosurg 53 516–527 Occurrence Handle7420174 Occurrence Handle1:STN:280:DyaL3M%2FislKgsQ%3D%3D
L Christensen SE Børgesen (1989) ArticleTitleSingle pulse pressure wave analysis by fast Fourier transformation. Neurol Res 11 197–200 Occurrence Handle2576101 Occurrence Handle1:STN:280:DyaK3c7lvFWiug%3D%3D
M Czosnyka JD Pickard (2004) ArticleTitleMonitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75 813–821 Occurrence Handle15145991 Occurrence Handle10.1136/jnnp.2003.033126 Occurrence Handle1:STN:280:DC%2BD2c3kslGmsw%3D%3D
PK Eide AD Fremming A Sorteberg (2003) ArticleTitleLack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand 108 381–388 Occurrence Handle14616289 Occurrence Handle10.1034/j.1600-0404.2003.00163.x Occurrence Handle1:STN:280:DC%2BD3srjs1agtg%3D%3D
PK Eide (2003) ArticleTitleThe relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography. Acta Neurochir (Wien) 145 171–179 Occurrence Handle10.1007/s00701-002-1062-y Occurrence Handle1:STN:280:DC%2BD3s7hslOqtw%3D%3D
PK Eide (2005) ArticleTitleAssessment of childhood intracranial pressure recordings using a new method of processing intracranial pressure signals. Ped Neurosurg 41 122–130
JHM van Eijndhoven CJJ Avezaat (1986) ArticleTitleCerebrospinal fluid pulse pressure and the pulsatile variation in cerebral blood volume: An experimental study in dogs. Neurosurgery 19 507–522 Occurrence Handle3097566 Occurrence Handle1:STN:280:DyaL2s%2FmsFGisw%3D%3D
EL Foltz C Aine (1981) ArticleTitleDiagnosis of hydrocephalus by CSF pulse-wave analysis: A clinical study. Surg Neurol 15 283–293 Occurrence Handle7245015 Occurrence Handle1:STN:280:DyaL3M3is1GqsQ%3D%3D
EL Foltz JP Blanks K Yonemura (1990) ArticleTitleCSF pulsatility in hydrocephalus: Respiratory effect on pulse wave slope as an indicator of intracranial compliance. Neurol Res 12 67–74 Occurrence Handle1974702 Occurrence Handle1:STN:280:DyaK3czkvFSgsA%3D%3D
JM Gonzales-Darder JL Barcia-Salorio (1989) ArticleTitlePulse amplitude and volume-pressure relationships in experimental hydrocephalus. Acta Neurochir (Wien) 97 166–170
D Greitz (2004) ArticleTitleRadiological assessment of hydrocephalus: New theories and implications for therapy. Neurosurg Rev 27 145–165 Occurrence Handle15164255
J Hamer E Alberti S Hoyer K Wiedemann (1977) ArticleTitleInfluence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves. J Neurosurg 46 36–45 Occurrence Handle830813 Occurrence Handle1:STN:280:DyaE2s%2FntlChtg%3D%3D
AO Hebb MD Cusimano (2001) ArticleTitleIdiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49 1166–1186 Occurrence Handle11846911 Occurrence Handle1:STN:280:DC%2BD387is1Oluw%3D%3D
O Hirai H Handa M Ishikawa SH Kim (1984) ArticleTitleEpidural pulse waveform as an indicator of intracranial pressure dynamics. Surg Neurol 21 67–74 Occurrence Handle6689813 Occurrence Handle1:STN:280:DyaL2c%2FntlKqsg%3D%3D
TW Langfitt JD Weinstein NF Kassell (1965) ArticleTitleCerebral vasomotor paralysis produced by intracranial hypertension. Neurology (Minneap) 15 622–641 Occurrence Handle1:STN:280:DyaF2M7htV2msA%3D%3D
J Löfgren C vonEssen NN Zwetnow (1973) ArticleTitleThe pressure-volume curve of the cerebrospinal fluid space in dogs. Acta Neurol Scand 49 557–574 Occurrence Handle4770652
A Marmarou K Shulman J LaMorgese (1975) ArticleTitleCompartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43 523–534 Occurrence Handle1181384 Occurrence Handle1:STN:280:DyaE28%2FkslGnsg%3D%3D
JD Miller J Garibi JD Pickard (1973) ArticleTitleInduced changes of cerebrospinal fluid volume. Effects during continuous monitoring of ventricular fluid pressure. Arch Neurol 28 265–269 Occurrence Handle4688432 Occurrence Handle1:STN:280:DyaE3s7is1SrtA%3D%3D
H Nornes R Aaslid KF Lindegaard (1977) ArticleTitleIntracranial pulse pressure dynamics in patients with intracranial hypertension. Acta Neurochir (Wien) 38 177–186 Occurrence Handle1:STN:280:DyaE1c%2FjslWlsg%3D%3D
IR Piper KH Chan IR Whittle JD Miller (1993) ArticleTitleAn experimental study of cerebrovascular resistance, pressure transmission and craniospinal compliance. Neurosurgery 32 805–816 Occurrence Handle8492856 Occurrence Handle1:STN:280:DyaK3s3mtFCqtw%3D%3D
HD Portnoy M Chopp C Branch MB Shannon (1982) ArticleTitleCerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. J Neurosurg 56 666–678 Occurrence Handle7069479 Occurrence Handle1:STN:280:DyaL387mvFGhsQ%3D%3D
C Raftopoulos J Deleval C Chaskis A Leonard F Cantraine F Desmyttere S Clarysse J Brotchi (1994) ArticleTitleCognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35 397–405 Occurrence Handle7528358 Occurrence Handle1:STN:280:DyaK2M%2FpvVagsw%3D%3D
S Savolainen H Hurskainen L Paljärvi I Alafuzoff M Vapalathi (2002) ArticleTitleFive-year outcome of normal pressure hydrocephalus with or without a shunt: Predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien) 144 515–523 Occurrence Handle10.1007/s00701-002-0936-3 Occurrence Handle1:STN:280:DC%2BD38zmsFynsA%3D%3D
A Sorteberg PK Eide A Fremming (2004) ArticleTitleA prospective study on the clinical effect of surgical treatment of normal pressure hydrocephalus: the value of hydrodynamic evaluation. Br J Neurosurg 18 149–157 Occurrence Handle15176556 Occurrence Handle1:STN:280:DC%2BD2czhsVCmsw%3D%3D Occurrence Handle10.1080/02688690410001681000
TH Schwartz SS Yoon FW Cutruzzola RR Goodman (1996) ArticleTitleThird ventriculostomy: Postoperative ventricular size and outcome. Minim Invasive Neurosurg 39 122–129 Occurrence Handle9007831 Occurrence Handle1:STN:280:DyaK2s7mtVeitw%3D%3D Occurrence Handle10.1055/s-2008-1052231
TH Schwartz B Ho CJ Prestigiacomo JN Bruce NA Feldstein RR Goodman (1999) ArticleTitleVentricular volume following third ventriculostomy. J Neurosurg 91 20–25 Occurrence Handle10389875 Occurrence Handle1:STN:280:DyaK1Mzhs1OgtQ%3D%3D
HA Wilkinson N Schuman J Ruggiero (1979) ArticleTitleNonvolumetric methods of detecting impaired intracranial compliance or reactivity. Pulse width and wave form analysis. J Neurosurg 50 758–767 Occurrence Handle438876 Occurrence Handle1:STN:280:DyaE1M7nsVOltA%3D%3D
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Eide, P. Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients treated with ventriculo-peritoneal shunts. Acta Neurochir (Wien) 148, 21–29 (2006). https://doi.org/10.1007/s00701-005-0654-8
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DOI: https://doi.org/10.1007/s00701-005-0654-8