Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución

Almansa, Angel Horcajadas; Tous, Nicolás Cordero; Cutillas, Ana Román; Infante, Ana Jorques; Rojas, Enrique Saura; Velasco, Benjamín; Corral, Carlos Sánchez

doi:10.1016/j.neucir.2014.07.002

Cited by 8 publications

(2 citation statements)

References 8 publications

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“…In cases where LOVA occurs with an open aqueduct, where it may be differentiated from Late Onset Idiopathic Aqueductal Stenosis (LIAS), it becomes more crucial to distinguish it from NPH due to their clinical and symptomatic overlap ( 157 ). ICP monitoring in LOVA patients was shown to correlate with patient conditions pre- and post-surgery ( 158 ), and CSF dynamics was recommended to differentiate them from NPH patients ( 159 ). A noninvasive and accurate diagnostic score consisting of clinical features like age, presence/absence of the Hakim triad, headache, nausea/vomit, and neuroradiological features (evaluated on MRI) like the head circumference, EI-x, 3 V width, DESH, sellar bone distortion with the bulging of the 3 V floor was proposed recently by Palandri et al ( 157 ) which was shown to classify probable NPH patients from LOVA and LIAS patients with a high AUC of 0.97, sensitivity of 95.1%, and specificity of 90.6%.…”

Section: Discussionmentioning

confidence: 99%

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

Kadaba Sridhar,

Dysterheft Robb,

Gupta

et al. 2024

Front. Neurol.

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IntroductionNormal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer’s Dementia (AD) and Parkinson’s Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem.MethodsBy searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans.ResultsStructural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment.ConclusionAlong with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.

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Section: Discussionmentioning

confidence: 99%

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

Kadaba Sridhar,

Dysterheft Robb,

Gupta

et al. 2024

Front. Neurol.

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“…Starting from the original classification parameters indicated by Oi et al, 7 Ved et al 10 adapted radiological criteria, and some authors reassessed the role of aqueductal stenosis. 11 Beyond iNPH, CSF dynamics have been extensively explored in CSF disorders such as aqueductal stenosis, 7,[12][13][14][15][16][17] but this important pathophysiological approach has been significantly understudied in LOVA.…”

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confidence: 99%

CSF dynamics in long-standing overt ventriculomegaly in adults

Pirina

Jusué-Torres

Desestret

et al. 2023

Neurosurgical Focus

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OBJECTIVE Long-standing overt ventriculomegaly in adults (LOVA) is a form of chronic hydrocephalus and its pathophysiology and treatment remain debated. An analysis of CSF dynamics in this condition has rarely been reported. The aim of this study was to analyze hydrodynamic characteristics of patients with suspected LOVA to discuss its pathophysiological mechanisms and the importance of CSF dynamics analysis for diagnosis and treatment of these patients. METHODS This retrospective cohort study, conducted between May 2018 and October 2022, included adult patients aged > 18 years investigated in a department of neurosurgery through a lumbar infusion study for suspicion of LOVA (n = 23). These patients were then compared with a control cohort explored for suspicion of idiopathic normal pressure hydrocephalus (iNPH; n = 30). Clinical symptoms, radiological findings, and hydrodynamic parameters were analyzed. The authors specifically compared two hydrodynamic parameters: resistance to CSF outflow, or Rout, which relies on CSF resorption, and pressure-volume index (PVI), which reflect overall craniospinal compliance. The lumbar infusion study was considered pathological (confirming the diagnosis of chronic hydrocephalus) when at least one of these two parameters was altered. RESULTS Rout was significantly less frequently increased (cutoff ≥ 12 mm Hg/ml/min) in patients with LOVA (52%) than in those with iNPH (97%; p < 0.001). In contrast, PVI was impaired (cutoff ≤ 25 ml) in both cohorts, i.e., in 61% of patients with LOVA and in 83% of patients with iNPH. Overall, the rate of pathological lumbar infusion study in LOVA (87%) was not statistically different than in iNPH (100%). However, PVI was the only impaired parameter most frequently found in those with LOVA (35%) compared with those with iNPH (3%; p = 0.002). CONCLUSIONS This study suggests that there is a differential CSF dynamics pattern when comparing patients with LOVA versus those with iNPH. A higher proportion of patients with LOVA showed isolated compliance impairment. These findings highlight the utility of CSF dynamics analysis for the evaluation of patients with suspected chronic obstructive hydrocephalus such as LOVA. Future research with larger case series may help define diagnosis and treatment algorithms of chronic obstructive hydrocephalus based on CSF dynamics analysis, in addition to clinical and radiological criteria.

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LOVA: the role of endoscopic third ventriculostomy and a new proposal for diagnostic criteria

et al. 2017

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The diagnostic criteria and management of this condition continue to be a topic of debate in the literature. The term definitive symptomatic LOVA (longstanding overt ventriculomegaly in adults) is applied to patients that fulfil a series of diagnostic criteria,which are reviewed in our paper. The main subject of our study is to propose a rearrangement of the criteria for the diagnosis of this entity and adjusted treatment strategies. We present our data evaluating the role of endoscopy in this pathology. This descriptive and analytical study comprised 27 adult patients with LOVA who underwent endoscopic third ventriculostomy (ETV). Data regarding age, gender and onset of symptoms, a previously implanted shunt, clinical examination and radiological findings at the time of diagnosis, and the intracranial pressure (ICP) recordings in some cases, were carefully retrospectively reviewed. ETV success was determined based on clinical state and radiological criteria. ETV was performed in all 27 cases. Mean follow up period was 4.2 years (6 months to 8 years). 2/27 patients (7.40%) were lost to follow-up. The overall success rate for ETV was 76% (21/25 patients). ETV resulted in shunt independency in two of the three patients with a previous shunt. Based on our results, we believe that ETV must be considered as the treatment of choice for patients with symptomatic LOVA.

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Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución

Cited by 8 publications

References 8 publications

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

CSF dynamics in long-standing overt ventriculomegaly in adults

LOVA: the role of endoscopic third ventriculostomy and a new proposal for diagnostic criteria

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