CSF dynamic analysis of a predictive pulsatility-based infusion test for normal pressure hydrocephalus

Qvarlander, Sara; Malm, Jan; Eklund, Anders

doi:10.1007/s11517-013-1110-1

Cited by 21 publications

(9 citation statements)

References 35 publications

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“…Szewczykowski, Avezaat, Czosnyka, and Qvarlander found a positive relationship between the overall CPA and mean value of CSFP waveform in subjects with and without CSF disorders, which is also consistent with the data reported in the current study, and shown in Fig. 2 [ 32 – 37 ]. However, some previous studies have also reported a region of constant compliance below 10 mmHg [ 32 , 35 – 37 ].…”

Section: Discussionsupporting

confidence: 92%

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Characteristics of the cerebrospinal fluid pressure waveform and craniospinal compliance in idiopathic intracranial hypertension subjects

Okon

Roberts

Mahmoud

et al. 2018

Fluids Barriers CNS

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BackgroundIdiopathic intracranial hypertension (IIH) is a condition of abnormally high intracranial pressure with an unknown etiology. The objective of this study is to characterize craniospinal compliance and measure the cerebrospinal fluid (CSF) pressure waveform as CSF is passively drained during a diagnostic and therapeutic lumbar puncture (LP) in IIH.MethodsEighteen subjects who met the Modified Dandy Criteria, including papilledema and visual field loss, received an ultrasound guided LP where CSF pressure (CSFP) was recorded at each increment of CSF removal. Joinpoint regression models were used to calculate compliance from CSF pressure and the corresponding volume removed at each increment for each subject. Twelve subjects had their CSFP waveform recorded with an electronic transducer. Body mass index, mean CSFP, and cerebral perfusion pressure (CPP) were also calculated. T-tests were used to compare measurements, and correlations were performed between parameters.ResultsCerebrospinal fluid pressure, CSFP pulse amplitude (CPA), and CPP were found to be significantly different (p < 0.05) before and after the LP. CSFP and CPA decreased after the LP, while CPP increased. The craniospinal compliance significantly increased (p < 0.05) post-LP. CPA and CSFP were significantly positively correlated.ConclusionsBoth low craniospinal compliance (at high CSFP) and high craniospinal compliance (at low CSFP) regions were determined. The CSFP waveform morphology in IIH was characterized and CPA was found to be positively correlated to the magnitude of CSFP. Future studies will investigate how craniospinal compliance may correlate to symptoms and/or response to therapy in IIH subjects.Electronic supplementary materialThe online version of this article (10.1186/s12987-018-0106-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

“…2 [ 32 – 37 ]. However, some previous studies have also reported a region of constant compliance below 10 mmHg [ 32 , 35 – 37 ]. None of our subjects were evaluated in this region, since the target closing pressure for the lumbar puncture was 12 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the cerebrospinal fluid pressure waveform and craniospinal compliance in idiopathic intracranial hypertension subjects

Okon

Roberts

Mahmoud

et al. 2018

Fluids Barriers CNS

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“…The ventricular compliance also decreases in the aging brain, thereby predisposing to CSF circulation disturbances as seen in idiopathic normal pressure hydrocephalus. 38 Predictive modeling allows for subgroups of aSAH patients with the highest likelihood of shunt placement for hydrocephalus to be identified. The use of RPA groups allows for multiple risk factors to be condensed into one ordinal scale to produce one number that reflects the risk profile.…”

Section: October 2016mentioning

confidence: 99%

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Adams

Ban

Leinonen

et al. 2016

Stroke

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A cute aneurysmal subarachnoid hemorrhage (aSAH) is a critical systemic condition, and survivors of the primary bleed require multidisciplinary neurointensive care. 1 People who survive aSAH carry an increased risk for various complications including epilepsy, depression, cognitive impairment, shunt requirement for hydrocephalus, and shunt complications. 1Hydrocephalus after aSAH has been reported to occur in 6% to 67% of the cases.2-6 The acute phase can be self-limiting in some patients, whereas others will require external ventricular drainage (EVD) to alleviate hydrocephalus symptoms. 7Whereas mechanisms of hydrocephalus development have not been fully elucidated, studies have suggested deterioration of the cerebrospinal fluid (CSF) dynamics, 3,8 obstructive mechanisms because of blood products, 3,9 disrupted absorption at the arachnoid granulations level, 3,10 or inflammation 11 as possible causes. For some patients, this will continue to develop into a chronic condition requiring permanent CSF diversion, Background and Purpose-Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus. Methods-A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves. Results-Of all patients alive ≥14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve-receiveroperating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68. Conclusions-Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines. The onlin...

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“…In the clinical assessment of normal pressure hydrocephalus (NPH) patients outflow resistance is considered to be a positive predictor of improvement following shunt surgery. By lowering outflow resistance, shunt placement has a pronounced effect on the CSF dynamics (Malm, Lundkvist, Eklund, Koskinen, & Kristensen, ; Qvarlander, Lundkvist, Koskinen, Malm, & Eklund, ; Qvarlander, Malm, & Eklund, ; Qvarlander, Sundström, Malm, & Eklund, ). In this study, we addressed the issue of how changes in opening pressure and simulated abdominal pressure of an ASD affect the resistance of the CMAV when tested in vitro.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Codman microcerebrospinal fluid shunt

et al. 2018

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IntroductionVentriculo‐peritoneal cerebrospinal fluid (CSF) shunt is the most common method of treating pediatric hydrocephalus. The Codman microadjustable valve (CMAV) is a CSF shunt constructed for children. The objective of the study was (a) to analyze complications after insertion of a CMAV shunt in hydrocephalic children, (b) to analyze complications after replacing a CMAV by an adult‐type Codman Hakim adjustable valve shunt (CHAV), and to (c) analyze the in vitro characteristics of the CMAV shunt and correlate the findings with the clinical performance of the shunt.MethodsA retrospective study analyzed a cohort of hydrocephalic children who had received a CMAV shunt and later replaced by a CHAV shunt. We report on the complications that resulted from replacing the CMAV with the CHAV. We tested six CMAV shunts with or without an antisiphon device (ASD) in which opening pressure, resistance, sensitivity to abdominal pressure, ASD position dependency, and function were determined. The test results were correlated with the clinical performance of the shunt in the retrospective study.ResultsThirty‐seven children (19 boys, 18 girls) were identified. Within the first month after shunt placement, a total of 10 patients (27%) developed complications including infections, hygromas, and shunt dysfunction. Shunt survival varied from 1 week to 145 months. Over the 10‐year follow‐up period, 13 children had their shunts replaced, six of them with a CHAV without any further complications. A bench test of the CMAV was done to test whether the opening pressure was in agreement with the manufacturer's specifications. Our results were generally in agreement with specifications stated by the manufacturer.ConclusionReplacing a CMAV with a CHAV was well tolerated by the patients. Bench test results were generally in agreement with manufacturers specifications. Replacing a CMAV with a CHAV in pediatric hydrocephalus patients can be accomplished safely.

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CSF dynamic analysis of a predictive pulsatility-based infusion test for normal pressure hydrocephalus

Cited by 21 publications

References 35 publications

Characteristics of the cerebrospinal fluid pressure waveform and craniospinal compliance in idiopathic intracranial hypertension subjects

Characteristics of the cerebrospinal fluid pressure waveform and craniospinal compliance in idiopathic intracranial hypertension subjects

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Analysis of Codman microcerebrospinal fluid shunt

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