Virginia Levrini1, Matthew Garnett2, Eva Nabbanja2, Marek Czosnyka2, Zofia H Czosnyka2, Afroditi D Lalou2. 1. Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. virginialevrini@gmail.com. 2. Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Abstract
INTRODUCTION: Tools available for diagnosis of normal pressure hydrocephalus (NPH) and prediction of shunt-response are overnight ICP monitoring, infusion studies, and extended lumbar drainage (ELD). We investigated the shunt-response predictive value by infusion tests versus ELD. MATERIAL AND METHODS: We retrospectively recruited 83 patients who had undergone both infusion study and ELD assessments and compared infusion study hydrodynamics with improvement at clinic follow-up after ELD and after shunting. RESULTS: 62 patients had Rout >11 mmHg/mL/min. 28 Showed physiotherapy-documented improvement following ELD, and were selected for shunting, of which 21 were shunted. Of these, 19 showed improvement. Eight patients with Rout >20 mmHg/mL/min showed no response to ELD and were not shunted.There were 21 patients with Rout <11 mmHg/mL/min: five were shunted, showed improvement at follow-up, and had Rout >6 mmHg/mL/min. ICP amplitude did not differ at baseline or plateau between responders and non-responders. CONCLUSIONS: ELD response and CSF dynamics differed remarkably. All patients with Rout <6 mmHg/mL/min showed no improvement with ELD, indicating that ELD and shunting might be contraindicated in these subjects. High Rout patients with no response to ELD could merit further consideration.
INTRODUCTION: Tools available for diagnosis of normal pressure hydrocephalus (NPH) and prediction of shunt-response are overnight ICP monitoring, infusion studies, and extended lumbar drainage (ELD). We investigated the shunt-response predictive value by infusion tests versus ELD. MATERIAL AND METHODS: We retrospectively recruited 83 patients who had undergone both infusion study and ELD assessments and compared infusion study hydrodynamics with improvement at clinic follow-up after ELD and after shunting. RESULTS: 62 patients had Rout >11 mmHg/mL/min. 28 Showed physiotherapy-documented improvement following ELD, and were selected for shunting, of which 21 were shunted. Of these, 19 showed improvement. Eight patients with Rout >20 mmHg/mL/min showed no response to ELD and were not shunted.There were 21 patients with Rout <11 mmHg/mL/min: five were shunted, showed improvement at follow-up, and had Rout >6 mmHg/mL/min. ICP amplitude did not differ at baseline or plateau between responders and non-responders. CONCLUSIONS: ELD response and CSF dynamics differed remarkably. All patients with Rout <6 mmHg/mL/min showed no improvement with ELD, indicating that ELD and shunting might be contraindicated in these subjects. High Rout patients with no response to ELD could merit further consideration.
Authors: Eric W Sankey; Ignacio Jusué-Torres; Benjamin D Elder; C Rory Goodwin; Sachin Batra; Jamie Hoffberger; Jennifer Lu; Ari M Blitz; Daniele Rigamonti Journal: J Clin Neurosci Date: 2015-05-12 Impact factor: 1.961
Authors: Sharif Vakili; Dane Moran; Alice Hung; Benjamin D Elder; Lee Jeon; Hugo Fialho; Eric W Sankey; Ignacio Jusué-Torres; C Rory Goodwin; Jennifer Lu; Jamie Robison; Daniele Rigamonti Journal: Neurosurg Focus Date: 2016-09 Impact factor: 4.047
Authors: Ann Liu; Eric W Sankey; Ignacio Jusué-Torres; Mira A Patel; Benjamin D Elder; C Rory Goodwin; Jamie Hoffberger; Jennifer Lu; Daniele Rigamonti Journal: Clin Neurol Neurosurg Date: 2016-02-09 Impact factor: 1.876
Authors: Anne M Koivisto; Irina Alafuzoff; Sakari Savolainen; Anna Sutela; Jaana Rummukainen; Mitja Kurki; Juha E Jääskeläinen; Hilkka Soininen; Jaakko Rinne; Ville Leinonen Journal: Neurosurgery Date: 2013-01 Impact factor: 4.654
Authors: Katie A Peterson; George Savulich; Dan Jackson; Clare Killikelly; John D Pickard; Barbara J Sahakian Journal: J Neurol Date: 2016-03-26 Impact factor: 4.849