ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2020 October;64(5):420-6

DOI: 10.23736/S0390-5616.17.04092-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Quantitative analysis of cerebrospinal fluid dynamics at phase contrast cine-MRI: predictivity of neurosurgical “Shunt” responsiveness in patients with idiopathic normal pressure hydrocephalus

Alessandro STECCO ¹ ✉, Alessia CASSARÀ ¹, Alberto ZUCCALÀ ¹, Mihaela B. ANOAICA ¹, Egidio GENOVESE ¹, Pier G. CAR ², Gabriele P. PANZARASA ², Giuseppe GUZZARDI ¹, Alessandro CARRIERO ¹

¹ Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy; ² Department of Neurosurgery, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy

BACKGROUND: Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients.
METHODS: We retrospectively reviewed charts and MRI of 38 shunted patients (72.16±6.16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by t-test for baseline values and with repeated measures analysis of variance.
RESULTS: Twenty-six patients (68,4%) improved after VPS (mean time of symptom onset was 8.15±7.19 months). Mean preoperative ACSV value was 271.85±143.03, which decreased by 21.6% (mean 213±125.14) at the first month and 40.3% sixth months after VPS (mean 162.15±91.5). Twelve patients (31.6%) did not improve (mean time of symptom onset was 29±5.62 months). Mean preoperative ACSV value was 79.83±31.24, decreased to 8.7% (mean 72.83±28.66) at first month after VPS. 21.2% (mean 62.83±31.12) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (P<0.01), onset time of symptoms (P<0.01) and the changes in ACSV after one and six months in both groups (P<0.001).
CONCLUSIONS: ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment.

KEY WORDS: Stroke volume; Hydrocephalus, normal pressure; Magnetic resonance imaging