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Rovira À, Hodel J. Commentary: predictor of shunt response in idiopathic normal pressure hydrocephalus. Neuroradiology 2022; 64:2097-2099. [PMID: 36104627 DOI: 10.1007/s00234-022-03051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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2
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Can preoperative brain imaging features predict shunt response in idiopathic normal pressure hydrocephalus? A PRISMA review. Neuroradiology 2022; 64:2119-2133. [DOI: 10.1007/s00234-022-03021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
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Johannsson B, Munthe S, Poulsen FR, Pedersen CB. Idiopathic normal pressure hydrocephalus; treatment and outcome in the Region of Southern Denmark. Clin Neurol Neurosurg 2021; 213:107107. [PMID: 34974379 DOI: 10.1016/j.clineuro.2021.107107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/16/2021] [Accepted: 12/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent and cost-effective disease to treat. However, no gold standard exists to confidently select patients for shunt surgery. The aim of this study was to investigate how patients with suspected iNPH at our center responded to shunt surgery and to compare pre-surgical variables between shunt responders and non-responders. METHODS Preoperative baseline characteristics, MRI and/or CT scans were retrospectively obtained in 55 shunt-operated iNPH patients. Evan's index, third ventricle diameter, dilation of Sylvian fissures, tight high convexity, focal sulci, callosal angle, Rout value, MMSE score, CSF phosphorylated tau, CSF tau, and a combination of radiologic findings (DESH score) were compared according to whether or not patients expressed satisfactory response to shunt treatment at 1-month follow-up. RESULTS Multiple logistic regression controlling for age and gender (α = 0.05) showed that tight high convexity, dilated Sylvian fissures, focal sulci, CSF tau, CSF phosphorylated tau, and DESH score correlated significantly with subjective shunt response at 1-month follow-up. CONCLUSION In line with current literature, Shunt responders had lower levels of CSF tau and CSF phosphorylated tau compared to non-responders. While commonly used radiologic markers are of value, they can be aggregated into a score for better selection of shunt candidates.
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Affiliation(s)
- Bjarni Johannsson
- OPEN - Open Patient data Explorative Network, J. B. Winsløws Vej 9a, Odense, Denmark; Department of Clinical Research, University of Southern Denmark and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark; Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 9a, Odense, Denmark.
| | - Sune Munthe
- OPEN - Open Patient data Explorative Network, J. B. Winsløws Vej 9a, Odense, Denmark; Department of Clinical Research, University of Southern Denmark and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark; Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 9a, Odense, Denmark
| | - Frantz Rom Poulsen
- OPEN - Open Patient data Explorative Network, J. B. Winsløws Vej 9a, Odense, Denmark; Department of Clinical Research, University of Southern Denmark and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark; Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 9a, Odense, Denmark
| | - Christian Bonde Pedersen
- OPEN - Open Patient data Explorative Network, J. B. Winsløws Vej 9a, Odense, Denmark; Department of Clinical Research, University of Southern Denmark and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark; Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 9a, Odense, Denmark
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Borzage M, Saunders A, Hughes J, McComb JG, Blüml S, King KS. The First Examination of Diagnostic Performance of Automated Measurement of the Callosal Angle in 1856 Elderly Patients and Volunteers Indicates That 12.4% of Exams Met the Criteria for Possible Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2021; 42:1942-1948. [PMID: 34620589 PMCID: PMC8583275 DOI: 10.3174/ajnr.a7294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with dementia may have comorbid or misdiagnosed normal pressure hydrocephalus, a treatable neurologic disorder. The callosal angle is a validated biomarker for normal pressure hydrocephalus with 93% diagnostic accuracy. Our purpose was to develop and evaluate an algorithm for automatically computing callosal angles from MR images of the brain. MATERIALS AND METHODS This article reports the results of analyzing callosal angles from 1856 subjects with 5264 MR images from the Open Access Series of Imaging Studies and the Alzheimer's Disease Neuroimaging Initiative databases. Measurement variability was examined between 2 neuroradiologists (n = 50) and between manual and automatic measurements (n = 281); from differences in simulated head orientation; and from real-world changes in patients with multiple examinations (n = 906). We evaluated the effectiveness of the automatic callosal angle to differentiate normal pressure hydrocephalus from Alzheimer disease in a simulated cohort. RESULTS The algorithm identified that 12.4% of subjects from these carefully screened cohorts had callosal angles of <90°, a published threshold for possible normal pressure hydrocephalus. The intraclass correlation coefficient was 0.97 for agreement between neuroradiologists and 0.90 for agreement between manual and automatic measurement. The method was robust to different head orientations. The median coefficient of variation for repeat examinations was 4.2% (Q1 = 3.1%, Q3 = 5.8%). The simulated classification of normal pressure hydrocephalus versus Alzheimer using the automatic callosal angle had an accuracy, sensitivity, and specificity of 0.87 each. CONCLUSIONS In even the most pristine research databases, analyses of the callosal angle indicate that some patients may have normal pressure hydrocephalus. The automatic callosal angle measurement can rapidly and objectively screen for normal pressure hydrocephalus in patients who would otherwise be misdiagnosed.
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Affiliation(s)
- M Borzage
- From the Fetal and Neonatal Institute, Division of Neonatology (M.B.)
- Department of Pediatrics (M.B.)
- Rudi Schulte Research Institute (M.B., A.S., S.B., K.S.K.), Santa Barbara, California
| | - A Saunders
- Department of Radiology (A.S., S.B.)
- Rudi Schulte Research Institute (M.B., A.S., S.B., K.S.K.), Santa Barbara, California
| | - J Hughes
- Department of Neuroradiology (J.H., K.S.K.), Barrow Neurological Institute, Phoenix, Arizona
| | - J G McComb
- Division of Neurosurgery (J.G.M.), Children's Hospital Los Angeles, Los Angeles, California
- Neurological Surgery (J.G.M.), Keck School of Medicine, University of Southern California, Los Angeles, California
| | - S Blüml
- Department of Radiology (A.S., S.B.)
- Rudi Schulte Research Institute (M.B., A.S., S.B., K.S.K.), Santa Barbara, California
| | - K S King
- Rudi Schulte Research Institute (M.B., A.S., S.B., K.S.K.), Santa Barbara, California
- Department of Neuroradiology (J.H., K.S.K.), Barrow Neurological Institute, Phoenix, Arizona
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Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery. J Clin Med 2020; 9:jcm9041084. [PMID: 32290366 PMCID: PMC7230300 DOI: 10.3390/jcm9041084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/03/2023] Open
Abstract
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 99mTc- 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) (p < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (p < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (p = 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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Sartoretti T, Wyss M, Sartoretti E, Reischauer C, Hainc N, Graf N, Binkert C, Najafi A, Sartoretti-Schefer S. Sex and Age Dependencies of Aqueductal Cerebrospinal Fluid Dynamics Parameters in Healthy Subjects. Front Aging Neurosci 2019; 11:199. [PMID: 31427956 PMCID: PMC6688190 DOI: 10.3389/fnagi.2019.00199] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the influence of age and sex on 10 cerebrospinal fluid (CSF) flow dynamics parameters measured with an MR phase contrast (PC) sequence within the cerebral aqueduct at the level of the intercollicular sulcus. Materials and Methods 128 healthy subjects (66 female subjects with a mean age of 52.9 years and 62 male subjects with a mean age of 51.8 years) with a normal Evans index, normal medial temporal atrophy (MTA) score, and without known disorders of the CSF circulation were included in the study. A PC MR sequence on a 3T MR scanner was used. Ten different flow parameters were analyzed using postprocessing software. Ordinal and linear regression models were calculated. Results The parameters stroke volume (sex: p < 0.001, age: p = 0.003), forward flow volume (sex: p < 0.001, age: p = 0.002), backward flow volume (sex: p < 0.001, age: p = 0.018), absolute stroke volume (sex: p < 0.001, age: p = 0.005), mean flux (sex: p < 0.001, age: p = 0.001), peak velocity (sex: p = 0.009, age: p = 0.0016), and peak pressure gradient (sex: p = 0.029, age: p = 0.028) are significantly influenced by sex and age. The parameters regurgitant fraction, stroke distance, and mean velocity are not significantly influenced by sex and age. Conclusion CSF flow dynamics parameters measured in the cerebral aqueduct are partly age and sex dependent. For establishment of reliable reference values for clinical use in future studies, the impact of sex and age should be considered and incorporated.
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Affiliation(s)
- Thomas Sartoretti
- Laboratory of Translational Nutrition Biology, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Michael Wyss
- Philips Healthcare, Zurich, Switzerland.,Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Carolin Reischauer
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland
| | - Nicolin Hainc
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
| | | | - Christoph Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Arash Najafi
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Baroncini M, Kuchcinski G, Le Thuc V, Bourgeois P, Leroy HA, Baille G, Lebouvier T, Defebvre L. Is endoscopic third ventriculostomy safe and efficient in the treatment of obstructive chronic hydrocephalus in adults? A prospective clinical and MRI study. Acta Neurochir (Wien) 2019; 161:1353-1360. [PMID: 31069530 DOI: 10.1007/s00701-019-03932-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND In case of suspected normal pressure hydrocephalus, MRI is performed systematically and can sometimes highlight an obstruction of the flow pathways of the CSF (aqueductal stenosis or other downstream obstruction). It seems legitimate for these patients to ask the question of a treatment with endoscopic third ventriculostomy (ETV), even if the late decompensation of an obstruction may suggest an association with a CSF resorption disorder. The aim of this study was to evaluate clinical and radiological evolution after ETV in a group of elderly patients with an obstructive chronic hydrocephalus (OCH). METHODS ETV was performed in 15 patients with OCH between 2012 and 2017. Morphometric (callosal angle, ventricular surface, third ventricular width, and Evans' index) and velocimetric parameters (stroke volume of the aqueductal (SVa) CSF) parameters were measured prior and after surgery with brain MRI. The clinical score (mini-mental status examination (MMSE) and the modified Larsson's score, evaluating walking, autonomy, and incontinence) were performed pre- and postoperatively. RESULTS SVa was less than 15 μL/R-R in 12 out of the 15 patients; in the other three cases, the obstruction was located at a distance from the middle part of the aqueduct. Fourteen out of 15 patients were significantly improved: mean Larsson's score decreased from 3.8 to 0.6 (P ≤ 0.01) and mean MMSE increased from 25.7 to 28 (P = 0.084). Evans' index and ventricular area decreased postoperatively and the callosal angle increased (P ≤ 0.01). The mean follow-up lasted 17.9 months. No postoperative complications were observed. CONCLUSION ETV seems to be a safe and efficient alternative to shunt for chronic hydrocephalus with obstruction; the clinical improvement is usual and ventricular size decreases slightly.
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Affiliation(s)
- Marc Baroncini
- Department of Neurosurgery, Lille University Hospital (CHU Lille), University of Lille, Rue Emile Laine, Lille, France.
| | - Gregory Kuchcinski
- Department of Neuroradiology, Lille University Hospital (CHU Lille), University of Lille, Lille, France
| | - Vianney Le Thuc
- Department of Neuroradiology, Lille University Hospital (CHU Lille), University of Lille, Lille, France
| | - Philippe Bourgeois
- Department of Neurosurgery, Lille University Hospital (CHU Lille), University of Lille, Rue Emile Laine, Lille, France
| | - Henri Arthur Leroy
- Department of Neurosurgery, Lille University Hospital (CHU Lille), University of Lille, Rue Emile Laine, Lille, France
| | - Guillaume Baille
- Department of Neurology, Lille University Hospital (CHU Lille), University of Lille, Lille, France
| | - Thibaud Lebouvier
- Department of Neurology, Lille University Hospital (CHU Lille), University of Lille, Lille, France
| | - Luc Defebvre
- Department of Neurology, Lille University Hospital (CHU Lille), University of Lille, Lille, France
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Grahnke K, Jusue-Torres I, Szujewski C, Joyce C, Schneck M, Prabhu V, Anderson D. In Reply to the Letter to the Editor Regarding "The Quest for Predicting Sustained Shunt Response in Normal-Pressure Hydrocephalus: An Analysis of the Callosal Angle's Utility". World Neurosurg 2018; 119:453. [PMID: 30347574 DOI: 10.1016/j.wneu.2018.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Kurt Grahnke
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA.
| | - Ignacio Jusue-Torres
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Caroline Szujewski
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Cara Joyce
- Department of Public Health Sciences and Neurology, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Michael Schneck
- Department of Neurology, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Vikram Prabhu
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Douglas Anderson
- Department of Neurological Surgery, Loyola University School of Medicine, Maywood, Illinois, USA
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