uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Cesarini, Kristina G
Alternative names
Publications (10 of 12) Show all publications
Shanks, J., Bloch, K. M., Laurell, K., Cesarini, K. G., Fahlström, M., Larsson, E.-M. & Virhammar, J. (2019). Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery. American Journal of Neuroradiology, 40(3), 453-459
Open this publication in new window or tab >>Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery
Show others...
2019 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 40, no 3, p. 453-459Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Increased CSF stroke volume through the cerebral aqueduct has been proposed as a possible indicator of positive surgical outcome in patients with idiopathic normal pressure hydrocephalus; however, consensus is lacking. In this prospective study, we aimed to compare CSF flow parameters in patients with idiopathic normal pressure hydrocephalus with those in healthy controls and change after shunt surgery and to investigate whether any parameter could predict surgical outcome. MATERIALS AND METHODS: Twenty-one patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched healthy controls were prospectively included and examined clinically and with MR imaging of the brain. Eighteen patients were treated with shunt implantation and were re-examined clinically and with MR imaging the day before the operation and 3 months postoperatively. All MR imaging scans included a phase-contrast sequence. RESULTS: The median aqueductal CSF stroke volume was significantly larger in patients compared with healthy controls (103.5 mu L; interquartile range, 69.8-142.8 mu L) compared with 62.5 mu L (interquartile range, 58.3-73.8 mu L; P < .01) and was significantly reduced 3 months after shunt surgery from 94.8 mu L (interquartile range, 81-241 mu L) to 88 mu L (interquartile range, 51.8-173.3 mu L; P < .05). Net flow in the caudocranial direction (retrograde) was present in 11/21 patients and in 10/21 controls. Peak flow and net flow did not differ between patients and controls. There were no correlations between any CSF flow parameters and surgical outcomes. CONCLUSIONS: Aqueductal CSF stroke volume was increased in patients with idiopathic normal pressure hydrocephalus and decreased after shunt surgery, whereas retrograde aqueductal net flow did not seem to be specific for patients with idiopathic normal pressure hydrocephalus. On the basis of the results, the usefulness of CSF flow parameters to predict outcome after shunt surgery seem to be limited.

Place, publisher, year, edition, pages
AMER SOC NEURORADIOLOGY, 2019
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-380474 (URN)10.3174/ajnr.A5972 (DOI)000461201600016 ()30792248 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved
Virhammar, J., Laurell, K., Cesarini, K. G. & Larsson, E.-M. (2019). Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus. Journal of Neurosurgery, 130(1), 130-135
Open this publication in new window or tab >>Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus
2019 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 130, no 1, p. 130-135Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Postoperative decrease in ventricle size is usually not detectable either by visual assessment or by measuring the Evans index in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of the present study was to investigate whether the angle between the lateral ventricles (the callosal angle [CA]) increases and ventricular volume decreases after shunt surgery in patients with iNPH. METHODS Magnetic resonance imaging of the brain was performed before and 3 months after shunt surgery in 18 patients with iNPH. The CA and Evans index were measured on T1-weighted 3D MR images, and ventricular volume contralateral to the shunt valve was measured with quantitative MRI. RESULTS The CA was larger postoperatively (mean 78°, 95% CI 69°-87°) than preoperatively (mean 67°, 95% CI 60°-73°; p < 0.001). The volume of the lateral ventricle contralateral to the shunt valve decreased from 73 ml (95% CI 66-80 ml) preoperatively to 63 ml (95% CI 54-72 ml) postoperatively (p < 0.001). The Evans index was 0.365 (95% CI 0.35-0.38) preoperatively and 0.358 (95% CI 0.34-0.38) postoperatively (p < 0.05). Postoperative change of CA showed a negative correlation with change of ventricular volume (r = -0.76, p < 0.01). CONCLUSIONS In this sample of patients with iNPH, the CA increased and ventricular volume decreased after shunt surgery. The relative difference was most pronounced for the CA, indicating that this accessible, noninvasive radiological marker should be evaluated further as an indirect method to determine shunt function in patients with iNPH.

Keywords
AC-PC = anterior commissure–posterior commissure, CA = callosal angle, Evans index, ICC = intraclass correlation coefficient, IQR = interquartile range, MMSE = Mini-Mental State Examination, NPH, QRAPMASTER = quantification of relaxation times and proton density by multiecho acquisition of saturation-recovery with turbo spin-echo readout, callosal angle, iNPH = idiopathic normal pressure hydrocephalus, normal pressure hydrocephalus, postoperative radiology, quantitative MRI, shunt dysfunction
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-342228 (URN)10.3171/2017.8.JNS17547 (DOI)000454604000015 ()29393749 (PubMedID)
Funder
Erik, Karin och Gösta Selanders Foundation
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2019-01-28Bibliographically approved
Abu Hamdeh, S., Virhammar, J., Sehlin, D., Alafuzoff, I., Cesarini, K. G. & Marklund, N. (2018). Brain tissue Aβ42 levels are linked to shunt response in idiopathic normal pressure hydrocephalus. Journal of Neurosurgery, 1-9
Open this publication in new window or tab >>Brain tissue Aβ42 levels are linked to shunt response in idiopathic normal pressure hydrocephalus
Show others...
2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-9Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE The authors conducted a study to test if the cortical brain tissue levels of soluble amyloid beta (Aβ) reflect the propensity of cortical Aβ aggregate formation and may be an additional factor predicting surgical outcome following idiopathic normal pressure hydrocephalus (iNPH) treatment. METHODS Highly selective ELISAs (enzyme-linked immunosorbent assays) were used to quantify soluble Aβ40, Aβ42, and neurotoxic Aβ oligomers/protofibrils, associated with Aβ aggregation, in cortical biopsy samples obtained in patients with iNPH (n = 20), sampled during ventriculoperitoneal (VP) shunt surgery. Patients underwent pre- and postoperative (3-month) clinical assessment with a modified iNPH scale. The preoperative CSF biomarkers and the levels of soluble and insoluble Aβ species in cortical biopsy samples were analyzed for their association with a favorable outcome following the VP shunt procedure, defined as a ≥ 5-point increase in the iNPH scale. RESULTS The brain tissue levels of Aβ42 were negatively correlated with CSF Aβ42 (Spearman's r = -0.53, p < 0.05). The Aβ40, Aβ42, and Aβ oligomer/protofibril levels in cortical biopsy samples were higher in patients with insoluble cortical Aβ aggregates (p < 0.05). The preoperative CSF Aβ42 levels were similar in patients responding (n = 11) and not responding (n = 9) to VP shunt treatment at 3 months postsurgery. In contrast, the presence of cortical Aβ aggregates and high brain tissue Aβ42 levels were associated with a poor outcome following VP shunt treatment (p < 0.05). CONCLUSIONS Brain tissue measurements of soluble Aβ species are feasible. Since high Aβ42 levels in cortical biopsy samples obtained in patients with iNPH indicated a poor surgical outcome, tissue levels of Aβ species may be associated with the clinical response to shunt treatment.

Keywords
AD = Alzheimer’s disease, Alzheimer’s disease, Aβ = amyloid beta, Aβ oligomers, ELISA = enzyme-linked immunosorbent assay, HPtau = hyperphosphorylated tau protein, LOD = limit of detection, LP = lumboperitoneal, MMSE = Mini-Mental State Examination, VP = ventriculoperitoneal, amyloid-β, hydrocephalus, iNPH, iNPH = idiopathic normal pressure hydrocephalus
National Category
Neurology Clinical Laboratory Medicine
Research subject
Pathology
Identifiers
urn:nbn:se:uu:diva-342227 (URN)10.3171/2017.7.JNS171005 (DOI)000454604000014 ()29350601 (PubMedID)
Funder
The Swedish Brain Foundation
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2019-01-28Bibliographically approved
Libard, S., Laurell, K., Cesarini, K. G. & Alafuzoff, I. (2018). Progression of Alzheimer's Disease-Related Pathology and Cell Counts in a Patient with Idiopathic Normal Pressure Hydrocephalus. Journal of Alzheimer's Disease, 61(4), 1451-1461
Open this publication in new window or tab >>Progression of Alzheimer's Disease-Related Pathology and Cell Counts in a Patient with Idiopathic Normal Pressure Hydrocephalus
2018 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, no 4, p. 1451-1461Article in journal (Refereed) Published
Abstract [en]

We had an opportunity to assess the change observed in the brain regarding Alzheimer’s disease (AD)-related alterations, cell count, and inflammation that took place during a period of 21 months in a subject with a definite diagnosis of AD and idiopathic Normal Pressure Hydrocephalus (iNPH). Four neuronal markers, i.e., synaptophysin, microtubule associated protein 2, non-phosphorylated neurofilament H (SMI32), and embryonic lethal abnormal visual system proteins 3/4 HuC/HuD (HuC/HuD); three microglial markers CD68, Human Leucocytic Antigen DR, ionized calcium-binding adaptor molecule 1, glial fibrillary acidic protein (GFAP); and AD-related markers, hyperphosphorylated τ (HPτ) and amyloid-β (Aβ, Aβ40, Aβ42) were assessed. Morphometrically assessed immunoreactivity of all neuronal and all microglial markers and Aβ42 decreased parallel with an increase in the HPτ in the frontal cortex. The expression of GFAP was stable with time. The first sample was obtained during the therapeutic shunting procedure for iNPH, and the second sample was obtained postmortem. Negligible reactive changes were observed surrounding the shunt channel. In conclusion, in the late stage of AD with time, a neuronal loss, increase in the HPτ, and decrease in Aβ42 and microglia was observed, whereas the expression of GFAP was rather stable. The observations described here suggest that when a brain biopsy has been obtained from an adult subject with iNPH, the assessment of postmortem brain is of major significance.

Keywords
Amyloid-beta, astrocytes, hyperphosphorylated tau, idiopathic normal pressure hydrocephalus, immunohistochemistry, microglia, neurons
National Category
Neurosciences Neurology Clinical Laboratory Medicine
Research subject
Pathology
Identifiers
urn:nbn:se:uu:diva-346377 (URN)10.3233/JAD-170446 (DOI)000423364400018 ()29376849 (PubMedID)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2019-01-07Bibliographically approved
Sundström, N., Malm, J., Laurell, K., Lundin, F., Kahlon, B., Cesarini, K. G., . . . Wikkelso, C. (2017). Incidence and outcome of surgery for adult hydrocephalus patients in Sweden. British Journal of Neurosurgery, 31(1), 21-27
Open this publication in new window or tab >>Incidence and outcome of surgery for adult hydrocephalus patients in Sweden
Show others...
2017 (English)In: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046X, Vol. 31, no 1, p. 21-27Article in journal (Refereed) Published
Abstract [en]

Object: To present population-based and age related incidence of surgery and clinical outcome for adult patients operated for hydrocephalus, registered in the Swedish Hydrocephalus Quality Registry (SHQR). Methods: All patients registered in SHQR during 2004-2011 were included. Data on age, gender, type of hydrocephalus and type of surgery were extracted as well as three months outcome for patients with idiopathic normal pressure hydrocephalus (iNPH). Results: The material consisted of 2360 patients, 1229 men and 1131 women, age 63.8 +/- 14.4 years (mean standard deviation (SD)). The mean total incidence of surgery was 5.1 +/- 0.9 surgeries/100,000/year; 4.7 +/- 0.9 shunt surgeries and 0.4 +/- 0.1 endoscopic third ventriculostomies. For iNPH, secondary communicating hydrocephalus and obstructive hydrocephalus, the incidence of surgery was 2.2 +/- 0.8, 1.9 +/- 0.3 and 0.8 +/- 0.1/100,000/year, respectively. During 2004-2011, the incidence of surgery increased in total (p = .044), especially in age groups 70-79 years and > 80 years (p = .012 and p = .031). After surgery, 253 of 652 iNPH patients (38.8%) improved at least one step on the modified Rankin scale (mRS). Number needed to treat was 3.0 for improving one patient from unfavourable (mRS 3-5) to favourable (mRS 0-2). The mean score of a modified iNPH scale increased from 54 +/- 23 preoperatively to 63 +/- 25 postoperatively (p < .0001, n = 704), and 58% improved. No significant regional differences in incidence, surgical techniques or outcome were found. Conclusions: Incidence of hydrocephalus surgery increased significantly during 2004-2011, specifically in elderly patients. Surgical treatment of INPH markedly improved functional independence, but the improvement rate was low compared to recent single- and multicentre studies. Thus, the potential for surgical improvement is likely lower than generally reported when treating patients as part of everyday clinical care.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Hydrocephalus, normal pressure, surgical incidence, clinical outcome, hydrocephalus quality registry, population based
National Category
Surgery Neurology
Identifiers
urn:nbn:se:uu:diva-320700 (URN)10.1080/02688697.2016.1229749 (DOI)000394397400006 ()27619731 (PubMedID)
Available from: 2017-04-24 Created: 2017-04-24 Last updated: 2017-04-24Bibliographically approved
Elobeid, A., Laurell, K., Cesarini, K. G. & Alafuzoff, I. (2015). Correlations Between Mini-Mental State Examination Score, Cerebrospinal Fluid Biomarkers, and Pathology Observed in Brain Biopsies of Patients With Normal-Pressure Hydrocephalus. Journal of Neuropathology and Experimental Neurology, 74(5), 470-479
Open this publication in new window or tab >>Correlations Between Mini-Mental State Examination Score, Cerebrospinal Fluid Biomarkers, and Pathology Observed in Brain Biopsies of Patients With Normal-Pressure Hydrocephalus
2015 (English)In: Journal of Neuropathology and Experimental Neurology, ISSN 0022-3069, E-ISSN 1554-6578, Vol. 74, no 5, p. 470-479Article in journal (Refereed) Published
Abstract [en]

Alzheimer disease (AD)-related pathology was assessed in cortical biopsy samples of 111 patients with idiopathic normal-pressure hydrocephalus. Alzheimer disease hallmark lesions-beta-amyloid (A beta) and hyperphosphorylated tau (HPtau)-were observed in 47% of subjects, a percentage consistent with that for whole-brain assessment reported postmortem in unselected cohorts. Higher-immunostained area fraction of AD pathology corresponded with lower preoperative mini-mental state examination scores. Concomitant A beta and HPtau pathology, reminiscent of that observed in patients with AD, was observed in 22% of study subjects. There was a significant correlation between A beta-immunostained area fraction in tissue and A beta 42 (42-amino-acid form of A beta) in cerebrospinal fluid (CSF). Levels of A beta 42 were significantly lower in CSF in subjects with concomitant A beta and HPtau pathology compared with subjects lacking pathology. Moreover, a significant correlation between HPtau-immunostained area fraction and HPtau in CSF was noted. Both HPtau and total tau were significantly higher in CSF in subjects with concomitant A beta and HPtau pathology compared with subjects lacking pathology. The 42-amino-acid form of A beta (A beta 42) and HPtau in CSF were the most significant predictors of the presence of AD pathology in cortical biopsies. Long-term follow-up studies are warranted to assess whether all patients with idiopathic normal-pressure hydrocephalus with AD pathology progress to AD and to determine the pathologic substrate of idiopathic normal-pressure hydrocephalus.

Keywords
Amyloid beta, Cerebrospinal fluid biomarkers, Cognitive status, Hyperphosphorylated tau, Normal-pressure hydrocephalus
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:uu:diva-252677 (URN)10.1097/NEN.0000000000000191 (DOI)000353056400008 ()25868149 (PubMedID)
Available from: 2015-05-26 Created: 2015-05-11 Last updated: 2018-01-11Bibliographically approved
Virhammar, J., Laurell, K., Ahlgren, A., Cesarini, K. G. & Larsson, E.-M. (2014). Idiopathic normal pressure hydrocephalus: cerebral perfusion measured with pCASL before and repeatedly after CSF removal. Journal of Cerebral Blood Flow and Metabolism, 34(11), 1771-1778
Open this publication in new window or tab >>Idiopathic normal pressure hydrocephalus: cerebral perfusion measured with pCASL before and repeatedly after CSF removal
Show others...
2014 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 34, no 11, p. 1771-1778Article in journal (Refereed) Published
Abstract [en]

Pseudo-continuous arterial, spin labeling (pCASL) measurements were performed in 20 patients with idiopathic normal pressure hydrocephalus (iNPH) to investigate whether cerebral blood flow (CBF) increases during the first 24 hours after a cerebrospinal fluid tap test (CSF TT). Five pCASL magnetic resonance imaging (MRI) scans were performed. Two scans were performed before removal of 40 mL CSF, and the other three at 30 minutes, 4 hours, and 24 hours, respectively after the CSF TT. Thirteen different regions of interest (ROIs) were manually drawn on coregistered MR images. In patients with increased CBF in lateral and frontal white matter after the CSF TT, gait function improved more than it did in patients with decreased CBF in these regions. However, in the whole sample, there was no significant increase in CBF after CSF removal compared with baseline investigations. The repeatability of CBF measurements at baseline was high, with intraclass correlation coefficients of 0.60 to 0.90 for different ROIs, but the median regional variability was in the range of 5% to 17%. Our results indicate that CBF in white matter close to the lateral ventricles plays a role in the reversibility of symptoms after CSF removal in patients with iNPH.

Keywords
arterial spin labeling, cerebral blood flow, cerebral perfusion, normal pressure hydrocephalus, pCASL, volumetry
National Category
Neurology
Research subject
Neurology; Neurosurgery; Radiology; Neuroscience
Identifiers
urn:nbn:se:uu:diva-222771 (URN)10.1038/jcbfm.2014.138 (DOI)000344428800005 ()25138210 (PubMedID)
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2017-12-05Bibliographically approved
Virhammar, J., Laurell, K., Cesarini, K. G. & Larsson, E.-M. (2014). Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus. American Journal of Neuroradiology, 35(12), 2311-2318
Open this publication in new window or tab >>Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus
2014 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 35, no 12, p. 2311-2318Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE:

MR imaging is used in the diagnostic evaluation of patients with idiopathic normal pressure hydrocephalus. The aim of this study was to describe the prevalence of several imaging features and their prognostic use in the selection of shunt candidates with idiopathic normal pressure hydrocephalus.

MATERIALS AND METHODS:

Preoperative MR imaging scans of the brain were retrospectively evaluated in 108 patients with idiopathic normal pressure hydrocephalus who had undergone a standardized, clinical evaluation before and 12 months after shunt surgery. The MR imaging features investigated were the Evans index, callosal angle, narrow sulci at the high convexity, dilation of the Sylvian fissure, diameters of the third ventricle and temporal horns, disproportionately enlarged subarachnoid space hydrocephalus, flow void through the aqueduct, focal bulging of the roof of the lateral ventricles, deep white matter hyperintensities, periventricular hyperintensities, and focal widening of sulci and aqueductal stenosis.

RESULTS:

In logistic regression models, with shunt outcome as a dependent variable, the ORs for the independent variables, callosal angle, disproportionately enlarged subarachnoid space hydrocephalus, and temporal horns, were significant (P < .05), both in univariate analyses and when adjusted for age, sex, and previous stroke.

CONCLUSIONS:

A small callosal angle, wide temporal horns, and occurrence of disproportionately enlarged subarachnoid space hydrocephalus are common in patients with idiopathic normal pressure hydrocephalus and were significant predictors of a positive shunt outcome. These noninvasive and easily assessed radiologic markers could aid in the selection of candidates for shunt surgery.

National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-230020 (URN)10.3174/ajnr.A4046 (DOI)000346690500017 ()25012669 (PubMedID)
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2017-12-05Bibliographically approved
Virhammar, J., Laurell, K., Cesarini, K. G. & Larsson, E.-M. (2014). The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus. Journal of Neurosurgery, 120(1), 178-184
Open this publication in new window or tab >>The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus
2014 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 120, no 1, p. 178-184Article in journal (Refereed) Published
Abstract [en]

Object

Different neuroimaging biomarkers have been studied to find a tool for prediction of response to CSF shunting in idiopathic normal-pressure hydrocephalus (iNPH). The callosal angle (CA) has been described as useful in discriminating iNPH from ventricular dilation secondary to atrophy. However, the usefulness of the CA as a prognostic tool for the selection of shunt candidates among patients with iNPH is unclear. The aim of this study was to compare the CA in shunt responders with that in nonresponders and clarify whether the CA can serve as a predictor of the outcome.

Methods

Preoperative MRI brain scans were evaluated in 109 patients who had undergone shunt surgery for iNPH during 2006-2010. Multiplanar reconstruction was performed interactively to obtain a coronal image through the posterior commissure, perpendicular to the anterior-posterior commissure plane. The CA was measured as the angle between the lateral ventricles on the coronal image. The patients were examined clinically before surgery and at 12 months postoperatively.

Results

Shunt responders had a significantly smaller mean preoperative CA compared with nonresponders: 59° (95% CI 56°-63°) versus 68° (95% CI 61°-75°) (p < 0.05). A CA cutoff value of 63° showed the best prognostic accuracy.

Conclusions

The preoperative CA is smaller in patients whose condition improves after shunt surgery and may be a useful tool in the selection of shunt candidates among patients with iNPH.

Place, publisher, year, edition, pages
http://thejns.org/action/showCoverGallery?journalCode=jns: , 2014
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-208803 (URN)10.3171/2013.8.JNS13575 (DOI)000329087900027 ()24074491 (PubMedID)
Available from: 2013-10-08 Created: 2013-10-08 Last updated: 2017-12-06Bibliographically approved
Andersson, K., Manchester, I. R., Laurell, K., Cesarini, K. G., Malm, J. & Eklund, A. (2013). Measurement of CSF dynamics with oscillating pressure infusion. Acta Neurologica Scandinavica, 128(1), 17-23
Open this publication in new window or tab >>Measurement of CSF dynamics with oscillating pressure infusion
Show others...
2013 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 128, no 1, p. 17-23Article in journal (Refereed) Published
Abstract [en]

Introduction Infusion tests are used to diagnose and select patients with idiopathic normal pressure hydrocephalus (INPH) for shunt surgery. The test characterizes cerebrospinal fluid dynamics and estimates parameters of the cerebrospinal fluid system, the pressure-volume index (PVI) and the outflow conductance (Cout). The Oscillating Pressure Infusion (OPI) method was developed to improve the test and reduce the investigation time. The aim of this study was to evaluate the new OPI method by comparing it with an established reference method. Methods Forty-seven patients (age 71.2 +/- 8.9years) with communicating hydrocephalus underwent a preoperative lumbar infusion investigation with two consecutive infusion protocols, reference (42min) and new (20min), that is, 94 infusion tests in total. The OPI method estimated Cout and PVI simultaneously. A real-time analysis of reliability was applied to investigate the possibility of infusion time reduction. Results The difference in Cout between the methods was 1.2 +/- 1.8l/s/kPa (Rout=-0.8 +/- 3.5mmHg/ml/min), P<0.05, n=47. With the reliability analysis, the preset 20min of active infusion could have been even further reduced for 19 patients to between 10 and 19min. PVI was estimated to 16.1 +/- 6.9ml, n=47. Conclusions The novel Oscillating Pressure Infusion method produced real-time estimates of Cout including estimates of reliability that was in good agreement with the reference method and allows for a reduced and individualized investigation time.

Keywords
cerebrospinal fluid, hydrocephalus, normal pressure, intracranial pressure, CSF dynamics, outflow conductance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-204090 (URN)10.1111/ane.12063 (DOI)000320322300004 ()
Available from: 2013-07-23 Created: 2013-07-22 Last updated: 2017-12-06Bibliographically approved
Organisations

Search in DiVA

Show all publications