Utjecaj položaja tijela na tlak cerebrospinalne tekućine u bolesnika s normotenzivnim hidrocefalusom

doctoral thesis

• Title (english): The influence of body position on cerebrospinal fluid pressure in patients with normal pressure hydrocephalus
• Author: Nenad Kudelić
• Mentor: Marijan Klarica (mentor)
• Committee member: Miroslav Vukić (predsjednik povjerenstva)
• Committee member: Milan Radoš (član povjerenstva)
• Committee member: Marija Renić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-02-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Universal decimal classification (UDC): 617 - Surgery. Orthopaedics. Ophthalmology

Abstract

Budući da nije poznato kako se regulira likvorski tlak unutar kraniospinalnog
prostora, u ovom radu ispitali smo utjecaj promjene položaja tijela i volumena likvora
na tlak likvora u kranijskom i spinalnom prostoru kod 19 bolesnika sa normotenzivnim
hidrocefalusom. Korištenjem dviju volumetrijskih tehnika (CIVET i volBrain) uočeno je
kako volumen likvora u kranijskom prostoru iznosi oko 300 ml a metodom
poluautomatske segmentacije u spinalnom prostoru prosječno 114 ml, što je ukupno
znatno veći volumen likvora nego što se do sada smatralo. Smanjenje volumena
likvora lumbalnom punkcijom za 15 ml dovodi do pada likvorskog tlaka za prosječno
8,5 cm H2O što ukazuje da volumen cerebrospinalne tekućine u spinalnom prostoru
ima velik utjecaj na visinu tlaka likvora. Mjerenje tlaka likvora u kranijskom i
lumbalnom subarahnoidalnom prostoru u horizontalnom položaju ukazuje da je tlak
likvora u čitavom kraniospinalnom prostoru na istoj hidrostatskoj razini jednak, dok
pri podizanju tijela za 15° tlak u kranijskom prostoru pada a u spinalnom raste.
Opažena razlika tlakova u kraniju i spinalno odgovara upravo hidrostatskoj razlici. Po
prvi put je opaženo kako bolesnici koji su imali pozitivan klinički odgovor na
produženu eksternu lumbalnu drenažu imaju značajno veći volumen likvora u
spinalnom prostoru (prosječno oko 120 ml) što ukazuje na novi prediktivni čimbenik u
liječenju bolesnika sa normotenzivnim hidrocefalusom. Rezultati ukazuju kako se
likvorski tlak ponaša kao hidrostatski tlak i da ne ovisi o sekreciji, cirkulaciji i
apsorpciji likvora što je u skladu sa novim shvaćanjima fiziologije i patofiziologije
likvora.

Abstract (english)

Since it is unknown how cerebrospinal fluid (CSF) pressure within the craniospinal
space is regulated, in this paper we examined the influence of body position and CSF
volume on CSF pressure in the cranial and spinal space in 19 patients with normal
pressure hydrocephalus. Using two volumetric techniques for cranial (CIVET and
volBrain) and semi-automatic segmentation for spinal space, it was observed that the
cranial CSF volume is about 300 ml and the spinal CSF volume is 114 ml, which is a
much larger volume of CSF than was previously thought. Withdrawal of 15 ml of CSF
volume by lumbar puncture leads to a decrease in CSF pressure by average 8.5 cm
H2O, which indicates that the CSF volume in the spinal space has a great influence
on the level of CSF pressure. The measurement of CSF pressure in the horizontal
position in the cranial and lumbar subarachnoid spaces indicates that the CSF
pressure in the entire craniospinal space at the same hydrostatic level is same, while
lifting the body by 15° decreases the pressure in the cranial space and increases the
pressure in the spinal space. The observed difference in pressure between cranial
and spinal space corresponds exactly to the hydrostatic difference. For the first time,
it was observed that patients who had a positive clinical response to prolonged
external lumbar drainage had a significantly higher CSF spinal volume (around 120
ml on average) indicating a new predictive factor in the treatment of patients with
normal pressure hydrocephalus. The results indicate that CSF pressure behaves like
hydrostatic pressure and does not depend on the secretion, circulation and
absorption of cerebrospinal fluid, which is consistent

• Keywords: normotenzivni hidrocefalus; tlak cerebrospinalne tekućine; segmentacija; volumetrija
• Keywords (english): normal pressure hydrocephalus; CSF pressure; segmentation; volumetry
• Language: croatian
• URN:NBN: urn:nbn:hr:105:188548
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 96 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-05-17 10:11:55