Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus
IntroductionThe pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should have high sensitivity and high predictive value, there is often no positive clinical response to surgical...
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Frontiers Media S.A.
2023-10-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1234396/full |
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| author | Nenad Kudelić Ivan Koprek Milan Radoš Darko Orešković Ivana Jurjević Ivana Jurjević Marijan Klarica |
| author_facet | Nenad Kudelić Ivan Koprek Milan Radoš Darko Orešković Ivana Jurjević Ivana Jurjević Marijan Klarica |
| author_sort | Nenad Kudelić |
| collection | DOAJ |
| description | IntroductionThe pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should have high sensitivity and high predictive value, there is often no positive clinical response to surgical treatment.Materials and methodsIn our study, 19 patients with clinical and neuroradiological signs of iNPH were selected for preoperative evaluation and possible further surgical treatment according to the guidelines. MR volumetry of the intracranial and spinal space was performed. Patients were exposed to prolonged external lumbar drainage in excess of 10 ml per hour during 3 days. Clinical response to lumbar drainage was assessed by a walk test and a mini-mental test.ResultsTwelve of 19 patients showed a positive clinical response and underwent a shunting procedure. Volumetric values of intracranial space content in responders and non-responders showed no statistically significant difference. Total CSF volume (sum of cranial and spinal CSF volumes) was higher than previously published. No correlation was found between spinal canal length, CSF pressure, and CSF spinal volume. The results show that there is a significantly higher CSF volume in the spinal space in the responder group (n = 12) (120.5 ± 14.9 ml) compared with the non-responder group (103.1 ± 27.4 ml; n = 7).DiscussionThis study demonstrates for the first time that CSF volume in the spinal space may have predictive value in the preoperative assessment of iNPH patients. The results suggest that patients with increased spinal CSF volume have decreased compliance. Additional prospective randomized clinical trials are needed to confirm our results. |
| first_indexed | 2024-03-11T19:49:07Z |
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| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T19:49:07Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-29b1e62a2083468e8b819728cd92203e2023-10-05T12:37:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-10-011410.3389/fneur.2023.12343961234396Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalusNenad Kudelić0Ivan Koprek1Milan Radoš2Darko Orešković3Ivana Jurjević4Ivana Jurjević5Marijan Klarica6Department of Neurosurgery, General Hospital Varaždin, Varaždin, CroatiaDepartment of Neurosurgery, General Hospital Varaždin, Varaždin, CroatiaDepartment of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, CroatiaDepartment of Molecular Biology, Ruđer Bošković Institute, Zagreb, CroatiaDepartment of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, CroatiaDepartment of Neurology, University Hospital Centre Zagreb, Zagreb, CroatiaDepartment of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, CroatiaIntroductionThe pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should have high sensitivity and high predictive value, there is often no positive clinical response to surgical treatment.Materials and methodsIn our study, 19 patients with clinical and neuroradiological signs of iNPH were selected for preoperative evaluation and possible further surgical treatment according to the guidelines. MR volumetry of the intracranial and spinal space was performed. Patients were exposed to prolonged external lumbar drainage in excess of 10 ml per hour during 3 days. Clinical response to lumbar drainage was assessed by a walk test and a mini-mental test.ResultsTwelve of 19 patients showed a positive clinical response and underwent a shunting procedure. Volumetric values of intracranial space content in responders and non-responders showed no statistically significant difference. Total CSF volume (sum of cranial and spinal CSF volumes) was higher than previously published. No correlation was found between spinal canal length, CSF pressure, and CSF spinal volume. The results show that there is a significantly higher CSF volume in the spinal space in the responder group (n = 12) (120.5 ± 14.9 ml) compared with the non-responder group (103.1 ± 27.4 ml; n = 7).DiscussionThis study demonstrates for the first time that CSF volume in the spinal space may have predictive value in the preoperative assessment of iNPH patients. The results suggest that patients with increased spinal CSF volume have decreased compliance. Additional prospective randomized clinical trials are needed to confirm our results.https://www.frontiersin.org/articles/10.3389/fneur.2023.1234396/fullidiopathic normal-pressure hydrocephalusCSF volumecranial CSFspinal CSFprognostic testpreoperative assessment |
| spellingShingle | Nenad Kudelić Ivan Koprek Milan Radoš Darko Orešković Ivana Jurjević Ivana Jurjević Marijan Klarica Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus Frontiers in Neurology idiopathic normal-pressure hydrocephalus CSF volume cranial CSF spinal CSF prognostic test preoperative assessment |
| title | Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
| title_full | Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
| title_fullStr | Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
| title_full_unstemmed | Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
| title_short | Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
| title_sort | predictive value of spinal csf volume in the preoperative assessment of patients with idiopathic normal pressure hydrocephalus |
| topic | idiopathic normal-pressure hydrocephalus CSF volume cranial CSF spinal CSF prognostic test preoperative assessment |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1234396/full |
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