Cargando…
Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus
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 surgic...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585139/ https://www.ncbi.nlm.nih.gov/pubmed/37869132 http://dx.doi.org/10.3389/fneur.2023.1234396 |
_version_ | 1785122889360474112 |
---|---|
author | Kudelić, Nenad Koprek, Ivan Radoš, Milan Orešković, Darko Jurjević, Ivana Klarica, Marijan |
author_facet | Kudelić, Nenad Koprek, Ivan Radoš, Milan Orešković, Darko Jurjević, Ivana Klarica, Marijan |
author_sort | Kudelić, Nenad |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10585139 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105851392023-10-20 Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus Kudelić, Nenad Koprek, Ivan Radoš, Milan Orešković, Darko Jurjević, Ivana Klarica, Marijan Front Neurol Neurology 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. Frontiers Media S.A. 2023-10-05 /pmc/articles/PMC10585139/ /pubmed/37869132 http://dx.doi.org/10.3389/fneur.2023.1234396 Text en Copyright © 2023 Kudelić, Koprek, Radoš, Orešković, Jurjević and Klarica. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Kudelić, Nenad Koprek, Ivan Radoš, Milan Orešković, Darko Jurjević, Ivana Klarica, Marijan Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus |
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 | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585139/ https://www.ncbi.nlm.nih.gov/pubmed/37869132 http://dx.doi.org/10.3389/fneur.2023.1234396 |
work_keys_str_mv | AT kudelicnenad predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus AT koprekivan predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus AT radosmilan predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus AT oreskovicdarko predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus AT jurjevicivana predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus AT klaricamarijan predictivevalueofspinalcsfvolumeinthepreoperativeassessmentofpatientswithidiopathicnormalpressurehydrocephalus |