Preoperative differentiation between responders and non-responders to ventriculoperitoneal (VP) shunting in the treatment of normal pressure hydrocephalus (NPH) remains a significant challenge. Identifying biomarkers in presurgical assessment represents a promising approach to reducing the need for invasive cerebrospinal fluid CSF testing. In this prospective observational study, thirty adult patients were classified into Group A (responders to VP shunting) and Group B (non-responders) based on their responsiveness to invasive CSF testing. The overall clinical condition and Idiopathic NPH (iNPH) scale were assessed at baseline. Additionally, biomarker levels were compared between the two groups. Elevated levels of Neurofilament Light Chain (NfL) and Neurofilament Heavy Chain (NfH) in CSF and a reduced level of beta-amyloid Aβ42 were observed. No significant differences in biomarker levels were found between groups. Individual biomarkers demonstrated only poor predictive value (AUC = 0.37-0.53). Clinical factors were stronger predictors (AUC = 0.642-0.669), with no improvement when combined with all examined biomarkers (AUC = 0.428-0.431). No single biomarker reliably predicted confirmed postoperative shunt responsiveness among patients who underwent VP shunt placement and demonstrated clinical improvement. Clinical factors were stronger predictors, suggesting that patient history and clinical assessment (e.g., the iNPH scale) provide more reliable diagnostic information. Notably, combining biomarkers with clinical factors did not improve predictive accuracy.
- MeSH
- Amyloid beta-Peptides cerebrospinal fluid MeSH
- Biomarkers * cerebrospinal fluid MeSH
- Middle Aged MeSH
- Humans MeSH
- Neurofilament Proteins cerebrospinal fluid MeSH
- Hydrocephalus, Normal Pressure * surgery cerebrospinal fluid diagnosis MeSH
- Peptide Fragments cerebrospinal fluid MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Ventriculoperitoneal Shunt * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
BACKGROUND: The lumbar infusion test (LIT) is a routine part of the diagnostic process of various CSF dynamics disorders in adults. However, it is rarely used in the paediatric population due to a lack of evidence substantiating its efficacy and overall indications. METHODS: Articles utilizing the LIT in a paediatric cohort (≤ 18 years) were included according to the PRISMA guidelines with the Newcastle-Ottawa Scale to assess the risk of bias. This review was registered at PROSPERO database under number: CRD42024625857. RESULTS: A total of 15 studies, yielding 441 patients, were included in the review. The most common indications for LIT were to predict shunt responsiveness in hydrocephalus and idiopathic intracranial hypertension (IIH). In IIH, the interaction between cerebrospinal fluid pressure (CSFp) and sagittal sinus pressure (SSp) may offer valuable diagnostic insights and present a novel assessment approach. The LIT is a validated tool, especially effective for predicting shunt responsiveness and detecting malfunctions in both IIH and hydrocephalus. CONCLUSIONS: Data surrounding LIT usage in children is lacking and most studies are outdated. Caution is needed when interpreting resistance to outflow (Rout) due to potential overestimation, with more attention directed to CSFp and the pressure within the venous system coupling in IIH. Future studies should focus on standardizing LIT protocols across age groups with focusing more on signal characteristics rather than individual parameters and fostering interdisciplinary collaboration to optimize diagnostic accuracy.
- MeSH
- Child MeSH
- Hydrocephalus * diagnosis MeSH
- Humans MeSH
- Adolescent MeSH
- Child, Preschool MeSH
- Pseudotumor Cerebri * diagnosis MeSH
- Cerebrospinal Fluid Pressure * physiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Child, Preschool MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND AND PURPOSE: White matter changes assessed by DTI typically reflect tract functionality. This study aimed to investigate DTI parameter alterations in important regions pre- and postshunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH), alongside assessing the relationship between DTI parameters and clinical improvement. MATERIALS AND METHODS: Patients with probable iNPH underwent prospective preoperative MRI and comprehensive clinical work-up between 2017-2022. Patients with clinical symptoms of iNPH, positive result on a lumbar infusion test, and/or gait improvement after 120-hour lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy and mean diffusivity values for individual regions of interest were extracted from preoperative and postoperative MRI. These values were correlated with the clinical picture of individual patients. RESULTS: A total of 32 patients (73.59 ± 4.59 years) with definite iNPH were analyzed. Preoperative DTI characteristics of internal capsule and corona radiata correlated with the 1-year improvement in the Dutch Gait Scale postoperatively (all P < .036). Cognitive domain improvement after surgery in memory and psychomotor speed correlated with preoperative DTI values of cingulate gyrus (P = .050), uncinate fasciculus (P = .029), superior longitudinal fasciculus (P = .020), or corpus callosum (P < .045). CONCLUSIONS: DTI characteristics of white matter regions reflect clinical improvement after shunt surgery in patients with iNPH. They tend to improve toward physiologic DTI values, thus further accentuating the benefit of shunt surgery in both clinical and radiologic pictures.
- MeSH
- Anisotropy MeSH
- White Matter diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Hydrocephalus, Normal Pressure * surgery diagnostic imaging MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Cerebrospinal Fluid Shunts * MeSH
- Treatment Outcome MeSH
- Diffusion Tensor Imaging * methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND OBJECTIVES: Normal pressure hydrocephalus is a preventable and treatable cause of dementia. A telemetric prechamber allows individually tailored ventriculoperitoneal shunt valve adjustments in patients treated with the shunting procedure. METHODS: In this pilot, prospective randomized trial, 33 adult patients were divided into Group A (with an implanted telemetric prechamber) and Group B (without an implanted telemetric prechamber). The overall condition, Mini-Mental-State-Examination score, and gait test were evaluated 3, 6, 9, and 12 months after surgery. Additionally, the total number of ventriculoperitoneal shunt valve adjustments and their impact on the patient's condition (assessed by the idiopathic normal pressure hydrocephalus scale) were assessed. RESULTS: There were no differences in the proportion of patients showing improved gait, cognitive functions, or incontinence. Patients with a telemetric prechamber underwent significantly more valve adjustments (1.6 ± 1.1 vs. 0.8 ± 0.6; P = 0.037). Also, a greater difference (reduction) in the shunt initial and final valve setting was observed in the prechamber group (30.71 ± 24.95 vs. 15.26 ± 13.07 mm H2O; P = 0.049). CONCLUSIONS: A telemetric prechamber allowed more valve adjustments during the follow-up period and a greater difference (reduction) between the initial (perioperative) and final valve pressure settings. However, there was no difference in functional parameters between the groups at any time point of the study.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Hydrocephalus, Normal Pressure * surgery MeSH
- Pilot Projects MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Telemetry * methods instrumentation MeSH
- Ventriculoperitoneal Shunt * methods instrumentation MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
INTRODUCTION: The indication for endoscopic third ventriculostomy is often contested in children younger than 1 year. This study aims to establish the benefits of this modality in children with idiopathic congenital aqueductal stenosis. METHODS: Retrospective analysis was performed on patients <1 year old with idiopathic congenital aqueductal stenosis undergoing endoscopic third ventriculostomy between 2004 and 2020. Preoperative cerebral imaging was performed in all cases. Endoscopic third ventriculostomy efficacy and overall patient outcome were evaluated over the entirety of the monitoring period averaging 146 months (range, 34-218 months). Outcome was assessed by modified Rankin Scale score. Treatment success was assessed in relation to the Endoscopic Third Ventriculostomy Success Score (ETVSS), patient age, and perioperative findings of membranes in the interpeduncular cistern. RESULTS: The study comprised 14 children aged from 6 to 280 days, mean age 16 weeks, with 11 patients aged <6 months. The characteristic presentation was progressive macrocephaly, with the setting sun sign in 2 cases. The overall Endoscopic Third Ventriculostomy Success Score was 52.1%, whereas endoscopic third ventriculostomy was successful in 12 patients (85.7%) in the first year postoperation and in 11 cases (78.6%) in the long term. Endoscopic third ventriculostomy failure was not related to patient age (P > .99) or perioperative findings of interpeduncular cistern membranes (P = .51). Patient outcome averaged modified Rankin Scale score 1. Most children were without or with minimal disability. CONCLUSIONS: We consider endoscopic third ventriculostomy a safe and effective modality for the initial treatment of patients aged <1 year presenting with congenital aqueductal stenosis-based hydrocephalus.
- MeSH
- Hydrocephalus * surgery diagnostic imaging MeSH
- Infant MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Neuroendoscopy * methods MeSH
- Infant, Newborn MeSH
- Retrospective Studies MeSH
- Third Ventricle * surgery diagnostic imaging MeSH
- Ventriculostomy * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Infant MeSH
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive disease characterized by disproportionate ventricular enlargement at brain imaging with gait disturbance and an increased risk of falling. Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. RESEARCH QUESTION: How do gait parameters change 24 h after CSF tap test (CSFTT) and after ventriculoperitoneal shunt surgery? METHODS: The PRISMA guidelines were used to perform the systematic review. We conducted a search of the following electronic databases: PubMed, Medline, Web of Science and EBSCO. We included studies focusing on gait changes occurring 24 h after a CSFTT or after ventriculoperitoneal shunt surgery in patients with iNPH. All articles were assessed for methodological quality using an adapted version of The Standard Quality Assessment Criteria for Evaluating Primary Research Papers checklist. RESULTS: Twenty-seven studies were included in the systematic review. Studies were highly heterogeneous due to lack of standardization of CSFTT or shunt surgery methodology, with varying amounts of CSF removed during the tap test (20-50 ml) and varying time of outcome assessment after shunt surgery. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH. The most sensitive spatio-temporal parameter assessed 24 h after CSFTT was self-selected walking speed followed by stride length, which increased significantly. Cadence is hence not suitable to consider in the evaluation of effect of CSFTT and shunt surgery. Changes in balance-related gait parameters after CSFTT and shunt surgery are still a controversial area of research. CONCLUSION: Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH, but quantitative and standardized gait analysis procedures are missing. Changes in balance-related gait parameters after CSFTT might be useful in deciding whether to perform shunt surgery in iNPH patients who hope for improvement in gait ability. The dual-task paradigm after CSFTT could improve the clinical evaluation of higher level frontal gait disturbances in patients with suspected iNPH before shunting.
- MeSH
- Gait * physiology MeSH
- Humans MeSH
- Hydrocephalus, Normal Pressure * surgery physiopathology cerebrospinal fluid diagnosis MeSH
- Cerebrospinal Fluid Shunts MeSH
- Spinal Puncture methods MeSH
- Ventriculoperitoneal Shunt MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Systematic Review MeSH
INTRODUCTION: Various analgesics are used to control intense headaches in patients following subarachnoid hemorrhage. In addition to pain control, it has been shown that some analgesics can affect various pathophysiological cascades. Therefore, we devised a study to assess whether the use of metamizole has a significant impact on the development of ischemic complications, hydrocephalus, and the overall outcome in patients following aneurysmal subarachnoid hemorrhage in the context of the other non-opioids and opioids effects. METHODS: In our retrospective, single-center cohort study, we enrolled 192 patients diagnosed with subarachnoid hemorrhage. We recorded their initial clinical status, comorbidities, and the daily dosage of analgesics over 14 days of hospitalization after the onset of subarachnoid hemorrhage. Using univariate and subsequent multivariate logistic regression analysis, we assessed the influence of various factors, including analgesics, on the development of delayed cerebral ischemia and hydrocephalus, as well as on 2-week and 6-month outcomes. RESULTS: Although the administration of non-opioids, in general, had no effect on the development of delayed cerebral ischemia or hydrocephalus, the use of metamizole as the main analgesic was associated with a significantly lower chance of poor outcome at both 2-weeks and 6-months, as well as the development of delayed cerebral ischemia. As opioids were indicated primarily for analgosedation in mechanically ventilated patients with poor clinical status, their usage was associated with a significantly higher chance of poor outcome, delayed cerebral ischemia, and hydrocephalus. CONCLUSION: Our results suggest that the prescription of metamizole may be associated with better outcomes and a lower chance of delayed cerebral ischemia development in patients after subarachnoid hemorrhage. Considering the retrospective nature of our study and the limited worldwide availability of metamizole due to its prohibition in some countries, our results do not demonstrate a clear benefit but rather justify the need for subsequent prospective studies.
- MeSH
- Analgesics therapeutic use administration & dosage MeSH
- Anti-Inflammatory Agents, Non-Steroidal * therapeutic use administration & dosage MeSH
- Adult MeSH
- Hydrocephalus etiology MeSH
- Brain Ischemia drug therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Dipyrone * therapeutic use administration & dosage MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Subarachnoid Hemorrhage * drug therapy complications MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
UNLABELLED: PURPOSE : Phase contrast magnetic resonance imaging (PC-MRI) represents an opportunity to non-invasively investigate cerebral spinal fluid (CSF) flow in patients with idiopathic normal pressure hydrocephalus (iNPH). Studies in recent years have explored the diagnostic and prognostic value of PC-MRI derived parameters. This review aims to identify all PC-MRI studies of iNPH published since 2010, synthesise a review based on collated results, and analyse specific flow parameters identified in the selected studies. METHODS: Our protocol was prospectively registered on PROSPERO [CRD42020180826]. We systematically searched four databases: Pubmed, Web of Science, Ovid, and Cochrane library to identify all eligible studies. Quality assessment was performed using a modified Newcastle-Ottawa Scale [19]. Systematic review was conducted according to Prisma guidelines. A random-effects model was used to perform meta-analysis on the available flow parameters. RESULTS: Eighteen records were identified for inclusion. Five studies were eligible for meta-analysis, representing 107 iNPH patients and 82 controls. CSF flow parameters available for analysis were stroke volume and peak velocity. Both were significantly higher than controls (p = 0.0007 and p = 0.0045 respectively) according to our random-effects analysis, consistent with a model of hyper-dynamic CSF in iNPH. Our systematic review revealed average stroke volumes in iNPH ranging from 43uL to over 200uL. Peak velocity values ranged from 5.9 cm/s to 12.8 cm/s. CONCLUSION: Significant increases in stroke volume and peak velocity values in iNPH patients suggest a place for PC-MRI as supplementary evidence in the diagnostic work-up of iNPH. Although shunting reduces aqueductal stroke volume and peak velocity, the ability of pre-shunt values to reliably predict treatment response remains complicated. We suggest that it may be more appropriate to consider a range of values that reflect varying probabilities of shunt success. We recommend that future studies should prioritise standardising PC-MRI protocols, and before then PC-MRI findings should be considered supportive rather than determinative.
- MeSH
- Humans MeSH
- Magnetic Resonance Imaging * methods MeSH
- Hydrocephalus, Normal Pressure * diagnostic imaging physiopathology surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
Počet pacientek s implantovaným shuntem dosahujících reprodukčního věku a plánujících těhotenství díky pokroku v léčbě hydrocefalu narůstá. Změny v organizmu matky, které souvisí především s akumulací vody v organizmu a s vzestupem intraabdominálního tlaku, se podílejí na zvýšené incidenci komplikací během gravidity a porodu. Proto je nutné řádné prekoncepční vyšetření, stanovení optimálního postupu v těhotenství a vhodného způsobu vedení porodu. Je nutné včas řešit specifické komplikace, které s dia gnózou hydrocefalu matky souvisí. Případná malfunkce shuntu je řešena individuálně dle aktuálního neurologického nálezu a s přihlédnutím k celkovému stavu pacientky a gestačnímu stáří. Vaginální porod je považován většinou autorů za bezpečný a je preferován. Primární císařský řez je indikován pouze u pacientek s anamnézou rychle progredujícího zhoršování neurologického stavu při malfunkci shuntu nebo při závažných komplikacích souvisejících s jeho porušenou funkcí. Při nekomplikovaném průběhu těhotenství s normálními hodnotami intrakraniálního tlaku lze při volbě anestezie využít jak celkovou, tak epidurální nebo spinální anestezii.
The number of patients with an implanted shunt reaching reproductive age and planning pregnancy is increasing thanks to advances in the treatment of hydrocephalus. Changes in the mother‘s organism, which are mainly related to the accumulation of water in the organism and the elevation of intra-abdominal pressure, contribute to the increased incidence of complications during pregnancy and childbirth. Therefore, it is necessary to make a preconception exam and specify pregnancy management, a suitable method of childbirth dealing with potential complications. Possible malfunction of the shunt is solved individually according to the current neurological findings and taking into account the patient‘s overall condition and gestational age. Vaginal delivery is considered safe and preferred by most authors. Primary caesarean section is indicated only in patients with a history of rapidly progressing deterioration of the neurological condition due to shunt malfunction or serious complications related to its impaired shunt function. In an uncomplicated pregnancy with normal values of intracranial pressure, both general and epidural or spinal anesthesia can be used when choosing anesthesia.
- MeSH
- Anesthesia classification methods MeSH
- Hydrocephalus * diagnosis complications MeSH
- Intracranial Pressure MeSH
- Pregnancy Complications classification MeSH
- Humans MeSH
- Parturition MeSH
- Cerebrospinal Fluid Shunts classification methods MeSH
- Pregnant People * MeSH
- Ventriculoperitoneal Shunt classification MeSH
- Ventriculostomy classification methods MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
