1
|
Zhang M, Olivero WC, Huston JM, Pappu S, Arnold PM, Biswas A, Anderson AT, Sutton BP. Measuring CSF shunt flow with MRI using flow enhancement of signal intensity (FENSI). Magn Reson Med 2024; 92:807-819. [PMID: 38469904 PMCID: PMC11142874 DOI: 10.1002/mrm.30079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE To develop and validate a noninvasive imaging technique for accurately assessing very slow CSF flow within shunt tubes in pediatric patients with hydrocephalus, aiming to identify obstructions that might impede CSF drainage. THEORY AND METHODS A simulation of shunt flow enhancement of signal intensity (shunt-FENSI) signal is used to establish the relationship between signal change and flow rate. The quantification of flow enhancement of signal intensity data involves normalization, curve fitting, and calibration to match simulated data. Additionally, a phase sweep method is introduced to accommodate the impact of magnetic field inhomogeneity on the flow measurement. The method is tested in flow phantoms, healthy adults, intensive care unit patients with external ventricular drains (EVD), and shunt patients. EVDs enable shunt-flow measurements to be acquired with a ground truth measure of CSF drainage. RESULTS The flow-rate-to-signal simulation establishes signal-flow relationships and takes into account the T1 of draining fluid. The phase sweep method accurately accounts for phase accumulation due to frequency offsets at the shunt. Results in phantom and healthy human participants reveal reliable quantification of flow rates using controlled flows and agreement with the flow simulation. EVD patients display reliable measures of flow rates. Shunt patient results demonstrate feasibility of the method and consistent flow rates for functional shunts. CONCLUSION The results demonstrate the technique's applicability, accuracy, and potential for diagnosing and noninvasively monitoring hydrocephalus. Limitations of the current approach include a high sensitivity to motion and strict requirement of imaging slice prescription.
Collapse
Affiliation(s)
- Mingxiao Zhang
- Department of Bioengineering, University of Illinois, Urbana, IL, USA
- Beckman Institute, University of Illinois, Urbana, IL, USA
| | - William C. Olivero
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Jason M. Huston
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, USA
- Department of Radiology, Carle Foundation Hospital, Urbana, IL, USA
| | - Suguna Pappu
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Paul M. Arnold
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Arundhati Biswas
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | | | - Bradley P. Sutton
- Department of Bioengineering, University of Illinois, Urbana, IL, USA
- Beckman Institute, University of Illinois, Urbana, IL, USA
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, USA
| |
Collapse
|
2
|
Iaccarino C, Chibbaro S, Sauvigny T, Timofeev I, Zaed I, Franchetti S, Mee H, Belli A, Buki A, De Bonis P, Demetriades AK, Depreitere B, Fountas K, Ganau M, Germanò A, Hutchinson P, Kolias A, Lindner D, Lippa L, Marklund N, McMahon C, Mielke D, Nasi D, Peul W, Poca MA, Pompucci A, Posti JP, Serban NL, Splavski B, Florian IS, Tasiou A, Zona G, Servadei F. Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel. BRAIN & SPINE 2024; 4:102761. [PMID: 38510640 PMCID: PMC10951750 DOI: 10.1016/j.bas.2024.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: "Diagnostic criteria for PTH" and "Surgical strategies for PTH and cranial reconstruction." Results The panel reached a consensus on 29 statements. In the "Diagnostic criteria for PTH" section, five statements were deemed "appropriate" (consensus 74.2-90.3 %), two were labeled "inappropriate," and seven were marked as "uncertain."In the "Surgical strategies for PTH and cranial reconstruction" section, four statements were considered "appropriate" (consensus 74.2-90.4 %), six were "inappropriate," and five were "uncertain." Discussion and conclusion Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.
Collapse
Affiliation(s)
- Corrado Iaccarino
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurosurgery Unit, University Hospital of Modena, Modena, Italy
- Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
| | - Salvatore Chibbaro
- Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK
- NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andras Buki
- Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - Kostantinos Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Dirk Lindner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Laura Lippa
- Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Catherine McMahon
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Davide Nasi
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Wilco Peul
- University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands
| | - Maria Antonia Poca
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Angelo Pompucci
- Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Jussi P. Posti
- Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland
| | | | - Bruno Splavski
- Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia
- Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
| | | | - Anastasia Tasiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gianluigi Zona
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Franco Servadei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
3
|
Cava FC, Castellani GB, Maietti E, Salucci P, Colombo V, Palandri G. A New Clinical Protocol for a Timely Diagnosis and Treatment of Hydrocephalus in Patients with Severe Acquired Brain Injury. Brain Sci 2023; 13:1067. [PMID: 37508999 PMCID: PMC10377718 DOI: 10.3390/brainsci13071067] [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: 06/29/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Secondary hydrocephalus is a well-known complication of severe acquired brain injuries (sABIs) often diagnosed during inpatient rehabilitation. Currently, there is no gold standard for its detection. Therefore, we designed a novel clinical diagnostic protocol that integrates clinical, functional, biochemical and neuroradiological assessments to improve the accuracy of its diagnosis in patients with sABIs. METHODS This prospective cohort study will be conducted in a tertiary referral rehabilitation center in Italy. A historical cohort of patients will be compared with a prospective cohort undergoing the new clinical diagnostic protocol. EXPECTED RESULTS The expected results include an increase in the proportion of diagnosed cases, a reduced incidence of clinical complications, an increase in the rehabilitative outcomes at discharge, a significant reduction in the length of hospital stay, and useful information about the diagnostic and prognostic value of the neuroradiological characteristics. CONCLUSION We expect that this clinical diagnostic protocol will result in a more appropriate assessment and timely treatment of secondary hydrocephalus in patients with sABIs, with the ultimate goal of improving their prognosis. In addition, it could be adopted by other rehabilitation centers to improve hydrocephalus diagnosis and treatment, thereby reducing the length of hospital stay and accelerating recovery with benefits for both patients and hospitals.
Collapse
Affiliation(s)
| | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Pamela Salucci
- Montecatone Rehabilitation Institute, 40026 Imola, Italy
| | | | - Giorgio Palandri
- Department of Neurosurgery, Institute of Neurological Sciences of Bologna IRCCS, Bellaria Hospital, 40139 Bologna, Italy
| |
Collapse
|
4
|
Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [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: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
Collapse
Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
| |
Collapse
|
5
|
Qiu X, Wang D, Chen L, Huang G, Zhou X, Chen Q, Wang Z. The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty. Front Neurol 2023; 13:1075137. [PMID: 36712427 PMCID: PMC9878597 DOI: 10.3389/fneur.2022.1075137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Cranioplasty (CP) and ventriculoperitoneal shunt (VPS) are procedures required after decompression of the flap (DC) to protect the cranial frame and prevent hydrocephalus. This study evaluated the safety and efficacy of different surgical sequences of CP and VPS after DC and identified risk factors for necessary permanent VPS. Methods From January 2017 to December 2021, valid follow-up data were collected in 192 cases. The observation group preferred CP, and then evaluated whether to receive VPS according to the progress of hydrocephalus. the control group was prioritized for VPS and continued with CP after 1 week. The improvement of hydrocephalus symptoms, follow-up outcomes, and post-operative complications before and after surgery were compared between the two groups, and univariate analysis was used to determine the risk factors for necessary permanent risk factors for VPS. Results There were 86 cases (44.8%) in the observation group, who received CP first, while 106 cases (55.2%) in the control group received VPS and CP, respectively. There was no significant difference between the two groups according to Barthel index, FMAS, Mrs, GCS, and Evans index, and there was no statistical difference in complications between the two groups. However, in the observation group, hydrocephalus disappeared after CP operation in 29 cases (33.7%), and finally avoided VPS. Univariate analysis showed that the main etiology was related to the size of the skull defect, the distance of the talus margin relative to the flap to the midline, and lumbar puncture pressure was a predictor of the need for permanent VPS. Conclusion This study provides detailed information on the efficacy and complications of different sequences of preferential CP or VPS after DC surgery. We found that priority CP reduced the incidence of VPS surgery without affecting surgical outcomes and complications.
Collapse
Affiliation(s)
- Xiansheng Qiu
- The Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Dong Wang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Li Chen
- Department of Neurosurgery, Fuzhou 900th Hospital of PLA, Fuzhou, Fujian, China
| | - Guanlin Huang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaoping Zhou
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qiang Chen
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Zhanxiang Wang
- The Graduate School of Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Zhanxiang Wang ✉
| |
Collapse
|
6
|
Corallo F, Maresca G, Formica C, Bonanno L, Bramanti A, Parasporo N, Giambò FM, De Cola MC, Lo Buono V. Humanoid Robot Use in Cognitive Rehabilitation of Patients with Severe Brain Injury: A Pilot Study. J Clin Med 2022; 11:jcm11102940. [PMID: 35629068 PMCID: PMC9146630 DOI: 10.3390/jcm11102940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 02/06/2023] Open
Abstract
Severe acquired brain injury (SABI) is a major global public health problem and a source of disability. A major contributor to disability after SABI is limited access to multidisciplinary rehabilitation, despite evidence of sustained functional gains, improved quality of life, increased return to work, and reduced need for long-term care. Twelve patients with a diagnosis of SABI were enrolled and equally divided into two groups: experimental and control. Patients in both groups underwent intensive neurorehabilitation according to the severity of their disabilities (motor, psycho-cognitive, and sensory deficits). However, in the experimental group, the treatment was performed by using a humanoid robot. At baseline, the two groups differed significantly only in Severe Impairment Battery (SIB) scores. Results showed that the experimental treatment had a higher effect than the traditional one on quality of life and mood. In conclusion, this pilot study provides evidence of the possible effects of relational and cognitive stimulation in more severely brain-injured patients.
Collapse
Affiliation(s)
- Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Giuseppa Maresca
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Caterina Formica
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry—Medical School of Salerno, University of Salerno, 84084 Fisciano, Italy;
| | - Nicholas Parasporo
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Fabio Mauro Giambò
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
- Correspondence:
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy; (F.C.); (G.M.); (C.F.); (L.B.); (N.P.); (F.M.G.); (V.L.B.)
| |
Collapse
|