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Assessment of Pressure-Volume Index During Lumbar Infusion Study: What Is the Optimal Method?

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Intracranial Pressure and Neuromonitoring XVII

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 131))

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Summary

Introduction: Assessment of the pressure-volume index (PVI) during lumbar infusion study (LIS) has been proposed to evaluate the overall compliance of the cranio-spinal system. It is calculated from the measurement of CSF pressure changes, ΔP from Pb to Pp, in response to repeated bolus injections of a volume (ΔV) within the lumbar subarachnoid space.

Material and Methods: We retrospectively analyzed 18 patients who underwent LIS for suspicion of normal pressure hydrocephalus, including a series of three fast bolus injections of 3 mL of saline at different levels of CSF pressure. We compared two methods for PVI calculation: (a) PVIslope using the slope α of a linear fit ΔP = α(Pb − P 0), PVI = ΔV/log10(α + 1); (b) PVImean using the PVI calculated independently for each bolus injection assuming P 0 = 0, PVI = mean(ΔV/log10(Ppi/Pbi))i=1.3.

Results: We found a significant discrepancy between the two methods: the average difference (PVIslope − PVImean) was −3.93 mL (95% confidence interval [8.77; –16.64]). In the PVIslope, method, the mean P 0 was 2.12 mmHg (±3.41 mmHg).

Discussion: The clinical reliability of PVImean (assuming P 0 = 0) depends on the value of P 0. PVIslope provides results, independent of P 0. Future studies should focus on determining pathological PVI range rather than fixed cut-off values.

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Authors and Affiliations

  1. Institute of Fluid Mechanics CNRS UMR 5502 & INSERM ToNIC, Toulouse, France

    Alexandra Vallet & Eric A. Schmidt

  2. Department of Intensive Care, Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint Etienne, France

    Laurent Gergelé

  3. Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital, Lyon, France

    Emmanuel Jouanneau & Romain Manet

  4. Department of Neurosurgery, Purpan University Hospital, Toulouse, France

    Eric A. Schmidt

Authors
  1. Alexandra Vallet
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  2. Laurent Gergelé
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  3. Emmanuel Jouanneau
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  4. Eric A. Schmidt
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  5. Romain Manet
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Corresponding author

Correspondence to Romain Manet .

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Editors and Affiliations

  1. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium

    Bart Depreitere

  2. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Geert Meyfroidt

  3. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Fabian Güiza

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Vallet, A., Gergelé, L., Jouanneau, E., Schmidt, E.A., Manet, R. (2021). Assessment of Pressure-Volume Index During Lumbar Infusion Study: What Is the Optimal Method?. In: Depreitere, B., Meyfroidt, G., Güiza, F. (eds) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement, vol 131. Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_64

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  • DOI: https://doi.org/10.1007/978-3-030-59436-7_64

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-59435-0

  • Online ISBN: 978-3-030-59436-7

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