Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus

Scientific paper - Original scientific paper

• Author: Nenad Kudelić
• Author: Ivan Koprek
• Author: Milan Radoš
• Author: Darko Orešković
• Author: Ivana Jurjević
• Author: Marijan Klarica
• Author's institution: University of Zagreb; School of Medicine; (Croatian Institiute for Brain Research)
• Author's institution: University of Zagreb; School of Medicine; (Department of Pharmacology)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Pharmacology

Abstract (english)

Introduction: The 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 methods: In 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.

Results: Twelve 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).

Discussion: This 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.

• Keywords (english): CSF volume; cranial CSF; idiopathic normal-pressure hydrocephalus; preoperative assessment; prognostic test; spinal CSF
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Frontiers in Neurology
• Numbering: vol. 14, 1234396
• e-ISSN: 1664-2295
• DOI: https://doi.org/10.3389/fneur.2023.1234396
• URN:NBN: urn:nbn:hr:105:426502
• Publication: 2023-10-05
• Project: Number: 108-1080231-0023; Title (croatian): Patofiziologija cerebrospinalnog likvora i intrakranijskog tlaka; Title (english): Pathophysiology of the cerebrospinal fluid and intracranial pressure; Leader: Marijan Klarica; Jurisdiction: Croatia; Funding stream: zProjects
• Project: Number: KK.01.1.1.01.0007; Title (croatian): Eksperimentalna i klinička istraživanja hipoksijsko-ishemijskog oštećenja mozga u perinatalnoj i odrasloj dobi; Title (english): .; Acronym: ZCI Neuro; Leader: Miloš Judaš; Jurisdiction: eu; Funding stream: European Regional Development Fund
• Document URL: https://www.frontiersin.org/articles/10.3389/fneur.2023.1234396/full
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-05-17 07:45:22