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Peña Pino I, Fellows E, McGovern RA, Chen CC, Sandoval-Garcia C. Structural and functional connectivity in hydrocephalus: a scoping review. Neurosurg Rev 2024; 47:201. [PMID: 38695962 DOI: 10.1007/s10143-024-02430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 06/26/2024]
Abstract
Optimizing the treatment of hydrocephalus remains a major challenge in adult and pediatric neurosurgery. Currently, clinical treatment relies heavily on anatomic imaging of ventricular size and clinical presentation. The emergence of functional and structural brain connectivity imaging has provided the basis for a new paradigm in the management of hydrocephalus. Here we review the pertinent advances in this field. Following PRISMA-ScR guidelines for scoping reviews, we searched PubMed for relevant literature from 1994 to April 2023 using hydrocephalus and MRI-related terms. Included articles reported original MRI data on human subjects with hydrocephalus, while excluding non-English or pre-1994 publications that didn't match the study framework. The review identified 44 studies that investigated functional and/or structural connectivity using various MRI techniques across different hydrocephalus populations. While there is significant heterogeneity in imaging technology and connectivity analysis, there is broad consensus in the literature that 1) hydrocephalus is associated with disruption of functional and structural connectivity, 2) this disruption in cerebral connectivity can be further associated with neurologic compromise 3) timely treatment of hydrocephalus restores both cerebral connectivity and neurologic compromise. The robustness and consistency of these findings vary as a function of patient age, hydrocephalus etiology, and the connectivity region of interest studied. Functional and structural brain connectivity imaging shows potential as an imaging biomarker that may facilitate optimization of hydrocephalus treatment. Future research should focus on standardizing regions of interest as well as identifying connectivity analysis most pertinent to clinical outcome.
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Affiliation(s)
- Isabela Peña Pino
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Emily Fellows
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
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Bagatto D, Piccolo D, Fabbro S, Copetti S, D'Agostini S, De Colle MC, Belgrado E, Tereshko Y, Valente M, Vindigni M, Tuniz F. Intravoxel incoherent motion magnetic resonance imaging in the assessment of brain microstructure and perfusion in idiopathic normal-pressure hydrocephalus. Neuroradiology 2024; 66:557-566. [PMID: 38273103 DOI: 10.1007/s00234-024-03291-5] [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: 09/03/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine the relationship between intravoxel incoherent motion (IVIM) MRI parameters and clinical changes post-tap test (TT) in idiopathic normal-pressure hydrocephalus (iNPH) patients. METHODS Forty-four probable iNPH patients underwent 3 T MRI before and after TT. IVIM parameters were calculated from eight different bilateral regions of interest in basal ganglia, centrum semiovale, and corona radiata. Patients were categorized based on TT response into positive (group 1) and negative (group 2) groups. A Welch two-sample t-test was used to compare differences in D, D*, f, and ADC between the two groups, while a paired t-test was employed to assess the changes within each group before and after TT. These parameters were then correlated with clinical results. RESULTS In the lenticular and thalamic nuclei, D value was significantly lower in the group 1 compared to group 2 both pre- and post-TT (p = 0.002 and p = 0.007 respectively). Post-TT, the positive response group exhibited a notably reduced D* value (p = 0.012) and significantly higher f values (p = 0.028). In the corona radiata and centrum semiovale, a significant post-TT reduction in D* was observed in the positive response group (p = 0.017). Within groups, the positive response cohort showed a significant post-TT increase in ADC (p < 0.001) and a decrease in D* (p = 0.007). CONCLUSION IVIM permits the acquisition of important non-invasive information about tissue and vascularization in iNPH patients. Enhanced perfusion in the lenticular and thalamic nuclei may suggest the role of re-established microvascular and glymphatic pathways, potentially elucidating the functional improvement in motor function after TT in iNPH patients.
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Affiliation(s)
- Daniele Bagatto
- Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Daniele Piccolo
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy.
- Clinic of Neurosurgery, Department of Neuroscience, University of Padua, Padua, (PD), Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, (PV), Italy.
| | - Sara Fabbro
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
- Unit of Neurosurgery, Department of Integrated Specialized Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, (TS), Italy
| | - Stefano Copetti
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Serena D'Agostini
- Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Maria Cristina De Colle
- Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Enrico Belgrado
- Unit of Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Yan Tereshko
- Unit of Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Mariarosaria Valente
- Unit of Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Marco Vindigni
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
| | - Francesco Tuniz
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, Udine, (UD), Italy
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Kudelić N, Koprek I, Radoš M, Orešković D, Jurjević I, Klarica M. Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus. Front Neurol 2023; 14:1234396. [PMID: 37869132 PMCID: PMC10585139 DOI: 10.3389/fneur.2023.1234396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
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.
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Affiliation(s)
- Nenad Kudelić
- Department of Neurosurgery, General Hospital Varaždin, Varaždin, Croatia
| | - Ivan Koprek
- Department of Neurosurgery, General Hospital Varaždin, Varaždin, Croatia
| | - Milan Radoš
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ivana Jurjević
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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Jeppsson A, Sandelius Å, Zettergren A, Kern S, Skoog I, Blennow K, Zetterberg H, Wikkelsø C, Hellström P, Tullberg M. Plasma and cerebrospinal fluid concentrations of neurofilament light protein correlate in patients with idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2023; 20:54. [PMID: 37415175 DOI: 10.1186/s12987-023-00455-y] [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: 03/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Neurofilament light chain protein (NFL), a marker of neuronal axonal degeneration, is increased in cerebrospinal fluid (CSF) of patients with idiopathic normal pressure hydrocephalus (iNPH). Assays for analysis of NFL in plasma are now widely available but plasma NFL has not been reported in iNPH patients. Our aim was to examine plasma NFL in iNPH patients and to evaluate the correlation between plasma and CSF levels, and whether NFL levels are associated with clinical symptoms and outcome after shunt surgery. METHODS Fifty iNPH patients with median age 73 who had their symptoms assessed with the iNPH scale and plasma and CSF NFL sampled pre- and median 9 months post-operatively. CSF plasma was compared with 50 healthy controls (HC) matched for age and gender. Concentrations of NFL were determined in plasma using an in-house Simoa method and in CSF using a commercially available ELISA method. RESULTS Plasma NFL was elevated in patients with iNPH compared to HC (iNPH: 45 (30-64) pg/mL; HC: 33 (26-50) (median; Q1-Q3), p = 0.029). Plasma and CSF NFL concentrations correlated in iNPH patients both pre- and postoperatively (r = 0.67 and 0.72, p < 0.001). We found only weak correlations between plasma or CSF NFL and clinical symptoms and no associations with outcome. A postoperative NFL increase was seen in CSF but not in plasma. CONCLUSIONS Plasma NFL is increased in iNPH patients and concentrations correlate with CSF NFL implying that plasma NFL can be used to assess evidence of axonal degeneration in iNPH. This finding opens a window for plasma samples to be used in future studies of other biomarkers in iNPH. NFL is probably not a very useful marker of symptomatology or for prediction of outcome in iNPH.
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Affiliation(s)
- A Jeppsson
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 7, 41345, Gothenburg, Sweden
| | - Å Sandelius
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Zettergren
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - S Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - I Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - K Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - C Wikkelsø
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 7, 41345, Gothenburg, Sweden
| | - P Hellström
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 7, 41345, Gothenburg, Sweden
| | - M Tullberg
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Blå Stråket 7, 41345, Gothenburg, Sweden.
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Bagatto D, Tereshko Y, Piccolo D, Fabbro S, De Colle MC, Morassi M, Belgrado E, Lettieri C, Gigli GL, Valente M, Skrap M, D'Agostini S, Tuniz F. Clinical applicability of arterial spin labeling magnetic resonance imaging in patients with possible idiopathic normal pressure hydrocephalus: A prospective preliminary study. Clin Neurol Neurosurg 2023; 227:107645. [PMID: 36871390 DOI: 10.1016/j.clineuro.2023.107645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE idiopathic Normal Pressure Hydrocephalus (iNPH) patients have a global reduction of cerebral blood flow (CBF) and Arterial Spin Label (ASL) MRI allows a global evaluation of CBF without the injection of contrast agents. This work aims to assess the qualitative evaluation agreement of ASL CBF colored maps between different neuroradiologists and by correlating these data to the Tap Test. METHODS Thirty - seven patients with the diagnosis of possible iNPH were consecutively submitted to a diagnostic MRI on a 1.5 Tesla Magnet before and after the lumbar infusion test and the Tap Test. Twenty - seven patients improved after the Tap Test and were addressed to surgery while 10 patients did not improve. All the MRI examinations included a 3D-Pulsed ASL sequence. Two different neuroradiologists independently reviewed all ASL images. They were asked to give a score (0 not improved; 1 improved) to global perfusion image quality by comparing ASL images obtained after the Tap Test to those obtained before. Comparison between inter- and intra-reader qualitative scores were performed with Cohen's kappa. RESULTS Inter-reader agreement between the two neuroradiologists showed that qualitative scores were attributed similarly by two readers (k = 0.83). This technique has a good PPV (90.5 %; CI 95 %, 72.7-97.1 %), NPV (50 %; CI 95 %, 34.1-65.6 %), SN (70.37 %; CI 95 %, 49.8-86.2 %) SP (80 %; CI 95 %, 44.4-97.5 %) and accuracy (73 %; CI 95 %, 55.9-86.2 %) when considered in the setting of possible iNPH patients. CONCLUSION ASL-MRI seems to be a promising non-invasive technique in the preoperative selection of patients affected by possible iNPH.
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Affiliation(s)
- Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy.
| | - Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Daniele Piccolo
- Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, Italy
| | - Sara Fabbro
- Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Maria Cristina De Colle
- Neuroradiology Unit, Department of Diagnostic Imaging, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Mauro Morassi
- Neuroradiology Unit, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Enrico Belgrado
- Neurology Unit, Department of Neurosciences, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Christian Lettieri
- Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Miran Skrap
- Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Serena D'Agostini
- Neuroradiology Unit, Department of Diagnostic Imaging, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Francesco Tuniz
- Neurosurgery Unit, Department of Neurosciences, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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