How does CSF dynamics change after shunting?

Petrella, Gianpaolo; Czosnyka, Marek; Keong, Nicole; Pickard, John D.; Czosnyka, Zofia

doi:10.1111/j.1600-0404.2008.01041.x

Cited by 43 publications

(45 citation statements)

References 21 publications

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“…Baseline ICP, intracranial elasticity, 16,17 RAP (an index of volume-compensatory reserve) were recorded in all patients as previously described. 16,19,23 CSF production and Rcsf were calculated as part of standard CSF infusion studies.…”

Section: Discussionmentioning

confidence: 99%

“…This approach was taken either because the patient was unable to tolerate the diagnostic procedure (which may require up to one hour of monitoring) or as a surgical strategy whereby native CSF dynamics can be assessed preoperatively and, if indicated, shunt insertion, can be performed within the same surgical session. [17][18][19] All patients presented with ventriculomegaly and with at least two elements of Hakim Triad symptoms (urinary incontinence, shuffling gait and memory loss); gait problems were present in all patients. Anaesthesia during the infusion study was induced using propofol, fentanyl and atracurium or vecuronium [20][21][22] and maintained with either propofol target-controlled infusion 3-6 mcg/ml effect site alone or combined with remifentanil 0.05-0.2 mcg/kg/ min.…”

Section: Methodsmentioning

confidence: 98%

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Influence of general anaesthesia on slow waves of intracranial pressure

Lalou

Czosnyka

Donnelly

et al. 2016

Neurological Research

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 98%

Influence of general anaesthesia on slow waves of intracranial pressure

Lalou

Czosnyka

Donnelly

et al. 2016

Neurological Research

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“…Evidence has previously been presented (Eide and Brean 2006, Eide and Sorteberg 2008, Eide and Brean 2010, Petrella et al 2008 for the suggestion that large amplitudes are a good predictor…”

Section: Predictive Testsmentioning

confidence: 99%

The pulsatility curve—the relationship between mean intracranial pressure and pulsation amplitude

2010

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Amplitude of cardiac related pulsations in intracranial pressure has recently been suggested as useful for selecting patients for shunt surgery in hydrocephalus. To better understand how shunting affects these pulsations, we aim to model the relationship of mean pressure and pulsation amplitude in a wide range, including the low pressures typically found after shunt surgery. Twenty-five patients with probable INPH were examined with lumbar constant pressure infusion investigations including drainage of cerebrospinal fluid. Mean pressure and pulsation amplitude were determined for consecutive 1.5 second intervals, starting at peak pressure (ca 35 mm Hg), after infusion, continuing during spontaneous return to baseline and drainage to 0 mm Hg. The amplitude versus pressure relationship revealed a linear phase at higher pressures (14-32 mm Hg, lack of fit test: p=0.79), a transitional phase, and an essentially constant phase at low pressures (0-10 mm Hg, slope=-0.02, lack of fit test: p=0.88). Individual patients' baseline values were found in all three phases. The model and methodology presented in this paper can be used to preoperatively identify patients with potential for postoperative amplitude decrease and to predict how much the amplitude can be reduced.Keywords: normal pressure hydrocephalus, pulse pressure, amplitudes, cerebrospinal fluid pressure, intracranial pressure, infusion test, arterial pulsationsThe pulsatility curve -Relationship between mean ICP and pulsation amplitude 3 All symbols and abbreviations are listed and explained in table 1.

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“…With a diagnosis of raised ICP the decision was made to perform an intra-operative infusion study [4,5] through the shunt prechamber to determine if the shunt was blocked and to gauge CSF dynamics (fig. 2).…”

Section: Case Reportmentioning

confidence: 99%

Combined Intracranial Pressure Monitoring and Cerebrospinal Fluid Infusion Study to Guide Management of Slit Ventricle Syndrome

Hart

Czosnyka²,

Czosnyka³

et al. 2013

Pediatr Neurosurg

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Introduction: Slit ventricle syndrome remains a complex entity presenting a considerable challenge to treat successfully. This study aims to demonstrate the application of dual intracranial pressure (ICP) and infusion studies together with the novel shunt occlusion test in both a diagnostic and therapeutic role. Case Report: An 8-year-old child had aqueduct stenosis treated with a ventriculoperitoneal shunt (medium-pressure valve). The presentation was of headaches with papilloedema. Imaging with both computed tomography and magnetic resonance imaging revealed slit ventricles. Initially a shunt exploration revealed distal obstruction that was treated together with insertion of a paediatric strata II regular valve; however, the child continued to deteriorate. Overnight ICP monitoring revealed dramatically raised ICP with poor compensatory reserve. Intra-operative infusion study revealed a shunt that was patent distally but with proximal obstruction. A subtemporal decompression ipsilateral to the shunt was performed together with adjustment of the paediatric strata II regular valve to 2.5 in order to prevent overdrainage. This led to normalisation of ICP, resolution of papilloedema and symptomatic improvement. Discussion: We demonstrate how combined ICP monitoring and shunt infusion studies can be used to help guide management. Unilateral subtemporal decompressions and preventing shunt overdrainage can result in normalisation of ICP and cerebrospinal fluid dynamics.

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How does CSF dynamics change after shunting?

Abstract: A functioning shunt has an important impact on CSF circulation and pressure-volume compensation. Infusion studies can demonstrate the return of disturbed CSF dynamics to normal values even if clinical or radiological changes are not dramatic.

Cited by 43 publications

References 21 publications

Influence of general anaesthesia on slow waves of intracranial pressure

Influence of general anaesthesia on slow waves of intracranial pressure

The pulsatility curve—the relationship between mean intracranial pressure and pulsation amplitude

Combined Intracranial Pressure Monitoring and Cerebrospinal Fluid Infusion Study to Guide Management of Slit Ventricle Syndrome

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