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Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Umeå University, Umeå, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.ORCID iD: 0000-0001-6308-1387
2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-6Article in journal (Refereed) Epub ahead of print
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.

Place, publisher, year, edition, pages
2018. p. 1-6
Keywords [en]
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
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Neurology
Identifiers
URN: urn:nbn:se:uu:diva-342228DOI: 10.3171/2017.8.JNS17547PubMedID: 29393749OAI: oai:DiVA.org:uu-342228DiVA, id: diva2:1183891
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-03-14Bibliographically approved

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Virhammar, JohanCesarini, Kristina GLarsson, Elna-Marie

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