Abstract
Normal pressure hydrocephalus is more complex than a simple disturbance of the cerebrospinal fluid (CSF) circulation. Nevertheless, an assessment of CSF dynamics is key to making decisions about shunt insertion, shunt malfunction, and for further management if a patient fails to improve. We summarize our 25 years of single center experience in CSF dynamics assessment using pressure measurement and analysis. 4473 computerized infusion tests have been performed. We have shown that CSF infusion studies are safe, with incidence of infection at less than 1%. Raised resistance to CSF outflow positively correlates (p < 0.014) with improvement after shunting and is associated with disturbance of cerebral blood flow and its autoregulation (p < 0.02). CSF infusion studies are valuable in assessing possible shunt malfunction in vivo and for avoiding unnecessary revisions. Infusion tests are safe and provide useful information for clinical decision-making for the management of patients suffering from hydrocephalus.
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References
Katzman R, Hussey F (1970) A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 20(6):534–544
Marmarou A, Shulman K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43(5):523–534
Czosnyka M, Czosnyka ZH, Whitfield PC, Donovan T, Pickard JD (2001) Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg 94(3):482–486
Nabbanja E, Czosnyka M, Keong NC, Garnett M, Pickard JD, Lalou DA, Czosnyka Z (2018) Is there a link between ICP-derived infusion test parameters and outcome after shunting in normal pressure hydrocephalus? Acta Neurochir Suppl 126:229–232
Czosnyka M, Wollk-Laniewski P, Batorski L, Zaworski W (1988) Analysis of intracranial pressure waveform during infusion test. Acta Neurochir 93(3–4):140–145
Petrella G, Czosnyka M, Smielewski P, Allin D, Guazzo EP, Pickard JD, Czosnyka ZH (2009) In vivo assessment of hydrocephalus shunt. Acta Neurol Scand 120(5):317–323
Czosnyka ZH, Czosnyka M, Whitfield PC, Donovan T, Pickard JD (2002) Cerebral autoregulation among patients with symptoms of hydrocephalus. Neurosurgery 50(3):526–532
Keong NC, Pena A, Price SJ, Czosnyka M, Czosnyka Z, DeVito EE, Housden CR, Sahakian BJ, Pickard JD (2017) Diffusion tensor imaging profiles reveal specific neural tract distortion in normal pressure hydrocephalus. PLoS One 12(8):e0181624. https://doi.org/10.1371/journal.pone.0181624. eCollection 2017.PMID:28817574
Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 127(Pt 5):965–972
Kasprowicz M, Czosnyka Z, Czosnyka M, Momjian S, Juniewicz H, Pickard JD (2004) Slight elevation of baseline intracranial pressure after fluid infusion into CSF space in patients with hydrocephalus. Neurol Res 26(6):628–631
Schmidt EA, Czosnyka Z, Momjian S, Czosnyka M, Bech RA, Pickard JD (2005) Intracranial baroreflex yielding an early cushing response in human. Acta Neurochir Suppl 95:253–256
Schmidt EA, Despas F, Pavy-Le Traon A, Czosnyka Z, Pickard JD, Rahmouni K, Pathak A, Senard JM (2018) Intracranial pressure is a determinant of sympathetic activity. Front Physiol 9:11. https://doi.org/10.3389/fphys.2018.00011. eCollection 2018
Ekstedt J (1978) CSF hydrodynamic studies in man: 2. Normal hydrodynamic variables related to CSF pressure and flow. J Neurol Neurosurg Psychiatry 41:345–353
Unnerbäck M, Ottesen JT, Reinstrup P (2018) ICP curve morphology and intracranial flow-volume changes: a simultaneous ICP and cine phase contrast MRI study in humans. Acta Neurochir 160(2):219–224
Acknowledgments
P.J.H. is supported by the NIHR: Research Professorship, Biomedical Research Centre and Global Health Research Group on Neurotrauma and the Royal College of Surgeons of England. J.D.P. supported by the MRC (Programme Grants) and the NIHR (Senior Investigator 2009–2014; Brain Injury Medtech cooperative 2013–2022). E.A.S. is supported by the Clinical Research Hospital Program from the French Ministry of Health (PHRC 2011-A01091-40) and by the Occitania Region research funding (RPBIO 2015 n°14054344). ZC, MC, PS are supported by EC INterreg program (REVERT).
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Czosnyka, Z.H. et al. (2021). Single Center Experience in Cerebrospinal Fluid Dynamics Testing. 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_58
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DOI: https://doi.org/10.1007/978-3-030-59436-7_58
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