Journal of Neurosurgery, Ahead of Print.
OBJECT The objective of this study was to assess the net aqueductal stroke volume (ASV) and CSF aqueductal flow rate derived from phase-contrast MRI (PC-MRI) in patients with probable idiopathic normal pressure hydrocephalus (iNPH) before and after ventriculoperitoneal shunt surgery, and to compare observations with intracranial pressure (ICP) scores. METHODS PC-MRI at the level of the sylvian aqueduct was undertaken in patients undergoing assessment for probable iNPH. Aqueductal flow in the craniocaudal direction was defined as positive, or antegrade flow, and net ASV was calculated by subtracting retrograde from antegrade aqueductal flow. Aqueductal flow rate per minute was calculated by multiplying net ASV by heart rate. During the same hospital admission, clinical examination was performed using NPH score and overnight continuous ICP monitoring. Twelve patients were followed prospectively 12 months after shunt placement with clinical assessment and a second PC-MRI. The study also included 2 healthy controls. RESULTS Among 21 patients examined for iNPH, 17 (81%) received a shunt (shunt group), and 4 were treated conservatively (conservative group). Among the patients with shunts, a clinical improvement was observed in 16 (94%) of the 17. Net ASV was negative in 16 (76%) of 21 patients before shunt placement and in 5 (42%) of 12 patients after shunt placement, and increased from a median of −5 μl (range −175 to 27 μl) to a median of 1 μl (range −61 to 30 μl; p = 0.04). Among the 12 patients with PC-MRI after shunt placement, 11 were shunt responders, and in 9 of these 11 either a reduced magnitude of retrograde aqueductal flow, or a complete reversal from retrograde to antegrade flow, occurred. Net ASV was significantly lower in the shunt group than in the conservative group (p = 0.01). The aqueductal flow rate increased from −0.56 ml/min (range −12.78 to 0.58 ml/min) to 0.06 ml/min (range −4.51 to 1.93 ml/min; p = 0.04) after shunt placement. CONCLUSIONS In this cohort of patients with iNPH, retrograde net aqueductal flow was observed in 16 (76%) of 21 patients. It was reversed toward the antegrade direction after shunt placement either by magnitude or completely in 9 (75%) of 12 patients examined using PC-MRI both before and after shunt placement (p = 0.04); 11 of the 12 were shunt responders. The study results question previously established concepts with respect to both CSF circulation pathways and CSF formation rate.
from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1lhFElh
via IFTTT
Αρχειοθήκη ιστολογίου
-
►
2020
(289)
- ► Φεβρουαρίου (28)
-
►
2019
(9071)
- ► Δεκεμβρίου (19)
- ► Σεπτεμβρίου (54)
- ► Φεβρουαρίου (3642)
- ► Ιανουαρίου (3200)
-
►
2018
(39872)
- ► Δεκεμβρίου (3318)
- ► Σεπτεμβρίου (3683)
- ► Φεβρουαρίου (2693)
- ► Ιανουαρίου (3198)
-
►
2017
(41099)
- ► Δεκεμβρίου (3127)
- ► Σεπτεμβρίου (2173)
-
►
2016
(13807)
- ► Δεκεμβρίου (700)
- ► Σεπτεμβρίου (600)
- ► Φεβρουαρίου (1350)
- ► Ιανουαρίου (1400)
-
▼
2015
(1500)
-
▼
Δεκεμβρίου
(1450)
-
▼
Δεκ 05
(46)
- Stroke prevention by direct revascularization for ...
- Growth hormone–secreting macroadenoma of the pitui...
- Metabolic approach for tumor delineation in glioma...
- Comparison of computer-assisted planning and manua...
- Effects of intracranial meningioma location, size,...
- Prospective, multidisciplinary recording of periop...
- Panventriculomegaly with a wide foramen of Magendi...
- Seizures in supratentorial meningioma: a systemati...
- Risk factors for worsened muscle strength after th...
- Phase-contrast magnetic resonance imaging reveals ...
- Tumors of the peripheral nervous system: analysis ...
- Hemodynamic and morphological characteristics of u...
- Editorial: Seizures with meningioma
- Letter to the Editor: Innovations in neurosurgery
- A biomechanical comparison of 3 different posterio...
- The unusual presentation of a vascular injury afte...
- Far caudally migrated extraforaminal lumbosacral d...
- Effects of fusion and conservative treatment on di...
- Editorial: Vascular injury during spinal procedures
- Therapiekonzepte der diffusen Peritonitis
- Peritonitis
- Long term results of postoperative Intensity-Modul...
- First evidence of the European wildcat ( Felis sil...
- Incidence of Ascaris suum -specific antibodies in ...
- A mucin-like peptide from Fasciola hepatica induce...
- Georgia Primary Care Providers’ Knowledge of Hered...
- Goodness and Desire
- Why do East Asian children perform so well in PISA...
- In the Long Cool Hour: "The Ethical Project" by Ph...
- Income Inequality, Intergenerational Mobility, and...
- Meaning, signification, and suggestion: Berkeley o...
- Microcarriers’ suspension and flow dynamics in orb...
- Political risk insurance and bilateral investment ...
- Centrifugal partition chromatography in a biorefin...
- Mapping pneumonia research: A systematic analysis ...
- Concurrent sexual partnerships among married Zimba...
- Studies of plug formation in microchannel liquid-l...
- A new small molecule inhibitor of soluble guanylat...
- Reconciling Magnetically Induced Vertigo and Nysta...
- The impact of threat of shock on the framing effec...
- Gastrointestinal stability of peptide drugs
- How beliefs about self-creation inflate value in t...
- Integrating Presentation Into Holistic Site Manage...
- An evaluation of the epidemiology of medication di...
- The evolution of chromatin folding in mammals: a r...
- Cutaneous Leishmaniasis - skin Barrier Properties ...
-
▼
Δεκ 05
(46)
-
▼
Δεκεμβρίου
(1450)
Ετικέτες
Σάββατο 5 Δεκεμβρίου 2015
Phase-contrast magnetic resonance imaging reveals net retrograde aqueductal flow in idiopathic normal pressure hydrocephalus
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου