Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience

Anile, Carmelo; Bonis, Pasquale De; Albanese, Alessio; Chirico, A. Di; Mangiola, Annunziato; Petrella, Gianpaolo; Santini, Pietro

doi:10.3171/2010.1.jns091296

Cited by 58 publications

(42 citation statements)

References 42 publications

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“…Previously investigated parameters which describe aspects of CSF dynamics similar to the pulsatility curve include the RAP Index21 (an index of cerebrospinal compensatory reserve) and the Elastance Index 34. The Elastance Index, which is similar to RPPC but uses diastolic pressure rather than mean ICP, has shown good predictive results for INPH in a previous study34 but RPPC did not predict gait improvement in this study.…”

Section: Discussionmentioning

confidence: 52%

Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus

Qvarlander

Lundkvist

Koskinen

et al. 2013

J Neurol Neurosurg Psychiatry

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Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus. Neurology, Neurosurgery and Psychiatry, 84 (7) Journal of ABSTRACT BackgroundIt is suggested that disturbed CSF dynamics are involved in the pathophysiology of idiopathic normal pressure hydrocephalus (INPH). The pulsatility curve describes the relationship between intracranial pressure (ICP) and amplitude of cardiac-related ICP pulsations. The position of baseline ICP on the curve provides information about the physiological state of the CSF dynamic system. The objective of the study was to investigate if shunt surgery modifies the pulsatility curve and the baseline position on the curve, and how this relates to gait improvement in INPH.

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Section: Discussionmentioning

confidence: 52%

Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus

Qvarlander

Lundkvist

Koskinen

et al. 2013

J Neurol Neurosurg Psychiatry

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“…An elevated outflow resistance has been shown to have prognostic power for selecting shunt responders (Boon et al 1997), but there are also studies showing a lack of prognostic power (Malm et al 1995). Similarly, one study (Anile et al 2010) showed a good prognostic power for a high intracranial elastance (IE) slope, which is closely related to RPPC, while another study demonstrated a lack of prognostic power for the slope of pulsation amplitude versus pressure (Delwel et al 2005).…”

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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“…More recently suggested prognostic tests often focus on parameters describing the cardiac-related pulsations in ICP or CSF flow. [5,10,17,31,33] So far no consensus on the most appropriate test has been reached, and the interaction of different CSF dynamic parameters complicates the effort of identifying the key aspect of the CSF dynamic disturbance. One test with promising results is based on the mean pulse amplitude of cardiacrelated ICP pulsations (AMPmean) during 10 minutes of constant flow infusion.…”

Section: Introductionmentioning

confidence: 99%

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

Qvarlander

Malm

Eklund

2013

Med Biol Eng Comput

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PostprintThis is the accepted version of a paper published in Medical and Biological Engineering and Computing. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the original published paper (version of record):Qvarlander, S., Malm, J., CSF dynamic analysis of a predictive pulsatility-based infusion test for normal pressure hydrocephalus.. Medical and Biological Engineering and Computing ABSTRACT IntroductionDisturbed cerebrospinal fluid (CSF) dynamics are part of the pathophysiology of Normal pressure hydrocephalus and can be modified and treated with shunt surgery. This study investigated the contribution of established CSF dynamic parameters to AMPmean, a prognostic variable defined as mean amplitude of cardiac-related intracranial pressure pulsations during 10 minutes of lumbar constant infusion, with the aim of claryfying the physiological interpretation of the variable.

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Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience

Abstract: Our strategy based on the analysis of CSF pulse pressure parameters seems to have a great accuracy in predicting surgical outcome in clinical practice.

Cited by 58 publications

References 42 publications

Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus

Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus

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

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

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