Paolo Mantovani1, Giulia Giannini2,3, David Milletti4, Sabina Cevoli2, Nicola Valsecchi3, Laura Ludovica Gramegna3,5, Luca Albini-Riccioli5, Carmelo Sturiale6, Pietro Cortelli3, Giuseppe Lanzino7, Benjamin D Elder7, Giorgio Palandri6. 1. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy. paolmantovani@gmail.com. 2. Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. 3. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. 4. UOSI Medicina Riabilitativa Intensiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. 5. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy. 6. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy. 7. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: In idiopathic normal pressure hydrocephalus (iNPH), gait and balance impairment is the most frequent symptom, and it is often associated with a higher fall risk. In a prior study, the anterior callosal angle (ACA) was validated as a reliable marker to discriminate iNPH from Alzheimer's disease and healthy controls. However, the potential correlation between the ACA with clinical symptoms and functional outcomes has not been assessed. The objective of this study is to determine the utility of the ACA in predicting gait improvement after ventriculoperitoneal (VP) shunting. METHODS: Patients with probable iNPH who underwent shunt placement at a single institution were prospectively enrolled from May 2015 to May 2019. Patients were assessed preoperatively and at 6 months postoperatively following a standard clinical and MRI protocol. Callosal angle (CA) and ACA were calculated from 3 T MRI preoperatively and at 6 months postoperatively. CA and ACA were tested for correlation with clinical scores. RESULTS: Forty-seven patients with probable INPH who completed 6-month postoperative follow-up were enrolled in the study. Baseline ACA was significantly correlated with preoperative fall risk, gait, and balance impairment assessed with Tinetti POMA scale. Additionally, baseline ACA differentiated patients who experienced improvement at Tinetti POMA scale after surgery. CONCLUSIONS: The baseline ACA is a useful neuroradiological marker to differentiate patients by fall risk and has significant correlation with the improvement in gait and balance impairment following surgery. This study demonstrated that the ACA may be a complementary tool to the CA in predicting shunt responsiveness in iNPH.
BACKGROUND: In idiopathic normal pressure hydrocephalus (iNPH), gait and balance impairment is the most frequent symptom, and it is often associated with a higher fall risk. In a prior study, the anterior callosal angle (ACA) was validated as a reliable marker to discriminate iNPH from Alzheimer's disease and healthy controls. However, the potential correlation between the ACA with clinical symptoms and functional outcomes has not been assessed. The objective of this study is to determine the utility of the ACA in predicting gait improvement after ventriculoperitoneal (VP) shunting. METHODS:Patients with probable iNPH who underwent shunt placement at a single institution were prospectively enrolled from May 2015 to May 2019. Patients were assessed preoperatively and at 6 months postoperatively following a standard clinical and MRI protocol. Callosal angle (CA) and ACA were calculated from 3 T MRI preoperatively and at 6 months postoperatively. CA and ACA were tested for correlation with clinical scores. RESULTS: Forty-seven patients with probable INPH who completed 6-month postoperative follow-up were enrolled in the study. Baseline ACA was significantly correlated with preoperative fall risk, gait, and balance impairment assessed with Tinetti POMA scale. Additionally, baseline ACA differentiated patients who experienced improvement at Tinetti POMA scale after surgery. CONCLUSIONS: The baseline ACA is a useful neuroradiological marker to differentiate patients by fall risk and has significant correlation with the improvement in gait and balance impairment following surgery. This study demonstrated that the ACA may be a complementary tool to the CA in predicting shunt responsiveness in iNPH.
Authors: Maria Mataró; Maria A Poca; Pilar Salgado-Pineda; Joan Castell-Conesa; Juan Sahuquillo; Maria Jesús Díez-Castro; Santiago Aguadé-Bruix; Pere Vendrell; Maria del Mar Matarín; Carme Junqué Journal: J Nucl Med Date: 2003-12 Impact factor: 10.057
Authors: Paolo Mantovani; Luca Albini-Riccioli; Giulia Giannini; David Milletti; Thomas J Sorenson; Michelangelo Stanzani-Maserati; Federico Oppi; Benjamin D Elder; Sabina Cevoli; Pietro Cortelli; Giorgio Palandri Journal: World Neurosurg Date: 2020-04-26 Impact factor: 2.104