Summary
In an attempt to determine to what extent the measurement of cerebrospinal fluid (CSF) outflow resistance (Rout) can distinguish patients with normal-pressure hydrocephalus (NPH) who respond to shunt surgery from patients who fail to do so, the authors undertook a controlled trial. Eighteen patients with the diagnosis of NPH entered the study. In connection with the shunt operation all patients who entered the study underwent Rout measurement by means of the pressure-volume index (PVI) method of bolus manipulation (Marmarouet al.). As a safety measure patients above 70 of age and patients with dementia as the only clinical symptom underwent continuous intraventricular pressure measurement before they entered the final study.
As a result a total of fourteen patients underwent PVI test and shunt surgery during the same procedure. Patients with normal Rout thus served as controls, since all patients underwent shunt surgery irrespective of the result of the Rout measurement. Eight patients improved following surgery and the outcome did not correlate with result of PVI nor Rout determinations.
Similar content being viewed by others
References
Artru AA (1984) Effects of halothane and fentanyl anesthesia on resistance to reabsorption of CSF. J Neurosurg 60: 252–256
Benvenuti D, Maiuri F, Lavano A, Volpentesta G, Giamundo A, Tecame S (1987) Postoperative intracerebral haemorrhages remote from the site of the initial operation. Br J Neurosurg 1: 377–384
Black PM (1980) Idiopatic normal-pressure hydrocephalus. Results of shunting in 62 patients. J Neurosurg 52: 371–377
BØrgesen SE (1984) Conductance to outflow of CSF in normal-pressure hydrocephalus. Acta Neurochir (Wien) 71: 1–45
BØrgesen SE, Gjerris F (1982) The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 105: 65–86
BØrgesen SE, Gyldensted C, Gjerris F, Lester J (1980) Computed tomography and pneumoencephalography compared to conductance to outflow of CSF in normal pressure hydrocephalus. Neuroradiology 20: 17–22
Chawla JG, Hulme A, Cooper R (1974) Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg 40: 376–380
Crockard HA, Hanlon K, Duda EE, Mullan JF (1977) Hydrocephalus as a cause of dementia: evaluation by computerized tomography and intracranial pressure monitoring. J Neurol Neurosurg Psychiatry 40: 736–740
Graff-Radford NR, Godersky JC (1986) Normal-pressure hydrocephalus. Onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 43: 940–942
Gücer G, Viernstein L, Walker AE (1980) Continuous intracranial pressure recording in adult hydrocephalus. Surg Neurol 13: 323–328
Hartmann A, Alberti E: Differentiation of communication hydrocephalus and presenile dementia by continuous recording of cerebrospinal fluid pressure. J Neurol Neurosurg Psychiatry 40: 630–640
Hughes CP, Siegel BA, Coxe WS, Gado MH, Grubb RL, Coleman RE, Berg L (1978) Adult idiopathic communicating hydrocephalus with and without shunting. J Neurol Neurosurg Psychiatry 41: 961–971
Kosteljanetz M (1985) Resistance to outflow of cerebrospinal fluid determined by bolus injection and constant rate infusion in humans. Neurosurgery 16: 336–340
Kosteljanetz M (1986) CSF dynamics and pressure-volume relationships in communicating hydrocephalus. J Neurosurg 64: 45–52
Kosteljanetz M (1987) Intracranial pressure: Cerebrospinal fluid dynamics and pressure-volume relations. Acta Neurol Scand [Suppl] 75: 1–23
Kosteljanetz M (1989) Measurement of resistance to outflow: The bolus injection method. In: Gjerris F, BØrgesen SE, Soelberg SØrensen P (eds) Outflow of cerebrospinal fluid. Alfred Benzon Symposium 27. Munksgaard, Copenhagen, pp 134–143
Kosteljanetz M (1989) Further analysis of the bolus-injection technique for resistance measurements. In: Hoff JT, Betz AL (eds) Intracranial pressure VII. Springer, Berlin Heidelberg New York Tokyo, pp 356–358
Kosteljanetz M, Ingstrup HM (1985) Normal pressure hydrocephalus, correlation between CT and measurements of cerebrospinal fluid dynamics. Acta Neurochir (Wien) 77: 8–13
Marmarou A, Shulman K, Rosende RM (1978) A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 48: 332–344
Schmidt JF, Fedders O, BØrgesen SE, Gjerris F (1989) Reproducibility of measurements of resistance to CSF outflow. In: Gjerris F, BØrgesen SE, Soelberg SØrensen P (eds) Outflow of cerebrospinal fluid. Alfred Benzon symposium 27. Munksgaard, Copenhagen, pp 224–229
Shapiro K, Marmarou A, Shulman K (1980) Characterisation of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol 7: 508–514
Sklar FH, Giller C, Shapiro K (1989) Manometric determinations of CSF absorption: Variance considerations. In: Gjerris F, BØrgesen SE, Soelberg SØrensen P (eds) Outflow of cerebrospinal fluid. Alfred Benzon symposium 27. Munksgaard, Copenhagen, pp 249–255
Stein SC, Langfitt TW (1974) Normal-pressure hydrocephalus. Predicting the results of cerebrospinal fluid shunting. J Neurosurg 41: 463–470
Tans JTJ, Poortvliet DCJ (1984) Comparison of ventricular steady-state infusion with bolus infusion and pressure recording for differentiating between arrested and non-arrested hydrocephalus. Acta Neurochir (Wien) 72: 15–29
Tans JTJ, Poortvliet DCJ (1989) Relationship between compliance and resistance to outflow of CSF in adult hydrocephalus. J Neurosurg 71: 59–62
Thomsen AM, BØrgesen SE, Bruhn P, Gjerris F (1986) Prognosis of dementia in normal-pressure hydrocephalus after a shunt operation. Ann Neurol 20: 304–310
Vassilouthis J (1984) The syndrome of normal-pressure hydrocephalus. J Neurosurg 61: 501–509
Vorstrup S, Christensen J, Gjerris F, SØrensen PS, Thomsen AM, Paulson OB (1987) Cerebral blood flow in patients with normal-pressure hydrocephalus before and after shunting. J Neurosurg 66: 379–386
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kosteljanetz, M., Nehen, A.M. & Kaalund, J. Cerebrospinal fluid outflow resistance measurements in the selection of patients for shunt surgery in the normal pressure hydrocephalus syndrome. A controlled trial. Acta neurochir 104, 48–53 (1990). https://doi.org/10.1007/BF01842893
Issue Date:
DOI: https://doi.org/10.1007/BF01842893