Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery
The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome f...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/4/1084 |
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| author | Tze-Wei Chang Pao-Hui Tseng Yi-Cheng Wang Guo-Fang Tseng Tsung-Lang Chiu Shinn-Zong Lin Sheng-Tzung Tsai |
| author_facet | Tze-Wei Chang Pao-Hui Tseng Yi-Cheng Wang Guo-Fang Tseng Tsung-Lang Chiu Shinn-Zong Lin Sheng-Tzung Tsai |
| author_sort | Tze-Wei Chang |
| collection | DOAJ |
| description | The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with <sup>99m</sup>Tc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) (<i>p</i> < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (<i>p</i> < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (<i>p</i> = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology. |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T20:32:07Z |
| publishDate | 2020-04-01 |
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| spelling | doaj.art-9eb8a9edf9c446439b7f1e3ad75aa1462023-11-19T21:19:32ZengMDPI AGJournal of Clinical Medicine2077-03832020-04-0194108410.3390/jcm9041084Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt SurgeryTze-Wei Chang0Pao-Hui Tseng1Yi-Cheng Wang2Guo-Fang Tseng3Tsung-Lang Chiu4Shinn-Zong Lin5Sheng-Tzung Tsai6Department of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanDepartment of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanDepartment of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanDepartment of Anatomy, College of Medicine, Tzu Chi University, Hualien 970, TaiwanDepartment of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanDepartment of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanDepartment of Neurosurgery, Hualien Tzu Chi Hospital/ Tzu Chi University, Hualien 970, TaiwanThe diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with <sup>99m</sup>Tc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) (<i>p</i> < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (<i>p</i> < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (<i>p</i> = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology.https://www.mdpi.com/2077-0383/9/4/1084normal pressure hydrocephalusdopaminergic degenerationsmall vessel diseaseshuntoutcome |
| spellingShingle | Tze-Wei Chang Pao-Hui Tseng Yi-Cheng Wang Guo-Fang Tseng Tsung-Lang Chiu Shinn-Zong Lin Sheng-Tzung Tsai Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery Journal of Clinical Medicine normal pressure hydrocephalus dopaminergic degeneration small vessel disease shunt outcome |
| title | Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery |
| title_full | Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery |
| title_fullStr | Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery |
| title_full_unstemmed | Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery |
| title_short | Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery |
| title_sort | dopaminergic degeneration and small vessel disease in patients with normal pressure hydrocephalus who underwent shunt surgery |
| topic | normal pressure hydrocephalus dopaminergic degeneration small vessel disease shunt outcome |
| url | https://www.mdpi.com/2077-0383/9/4/1084 |
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