Abstract
Objective: The management of post-traumatic ventriculomegaly (PTV) is controversial. This is due to the difficulty to determine whether PTV is related to an atrophic process or to a true "active" hydrocephalus. The purpose of this study is to analyze the CSF-dynamics in patients with PTV and, possibly, to identify parameters that correlate with prognosis. Methods: 15 patients with PTV were treated following this protocol: 1-frontal ventriculostomy (with Rickham reservoir); 2-CSF-dynamics evaluation; 3-ventriculo-peritoneal shunt. CSF dynamics evaluation was based on an intraventricular infusion test (performed three to five days after ventriculostomy). Outflow Resistance (R-out) and Intracranial Elastance Index (EI, i.e. the reciprocal of intracranial compliance) were calculated. Patients were classified according to response to shunt into: 1-fast responders: rapid clinical improvement, i.e. within days/one month from surgery; 2-slow responders: patients presenting little clinical improvement occurring after months (despite neurorehabilitation); 3-non responders: no clinical improvement. Results: Seven patients (46.7%) were classified as fast-responders, three patients were classified as slow-responders (20%) and five patients were classified as non-responders (33.3%). Opening CSF pressure was less than 15 mmHg for all patients. R-out (cut-off >10 mmHg/ml/min) had 100% sensitivity, 50% specificity, 100% negative predictive value and 63.6% positive predictive value. EI (cut-off value >0.3) had 100% specificity, 42.4% sensitivity, 100% positive predictive value and 66.7% negative predictive value. Conclusions: Based on these considerations, we can suggest that, for patients with normal pressure PTV, analysis of CSF dynamics could be of help in selecting patients for CSF-shunt. A combination of Intracranial Elastance and of R-out could help predicting shunt responsiveness.
| Original language | English |
|---|---|
| Pages (from-to) | 49-53 |
| Number of pages | 5 |
| Journal | Clinical Neurology and Neurosurgery |
| Volume | 115 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2013 |
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Keywords
- CSF dynamics
- CSF shunt
- Intracranial Elastance
- Outflow Resistance
- Post-traumatic hydrocephalus
- Post-traumatic ventriculomegaly
- Shunt responders
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
CSF dynamics analysis in patients with post-traumatic ventriculomegaly. / De Bonis, Pasquale; Mangiola, Annunziato; Pompucci, Angelo; Formisano, Rita; Mattogno, Pierpaolo; Anile, Carmelo.
In: Clinical Neurology and Neurosurgery, Vol. 115, No. 1, 01.2013, p. 49-53.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - CSF dynamics analysis in patients with post-traumatic ventriculomegaly
AU - De Bonis, Pasquale
AU - Mangiola, Annunziato
AU - Pompucci, Angelo
AU - Formisano, Rita
AU - Mattogno, Pierpaolo
AU - Anile, Carmelo
PY - 2013/1
Y1 - 2013/1
N2 - Objective: The management of post-traumatic ventriculomegaly (PTV) is controversial. This is due to the difficulty to determine whether PTV is related to an atrophic process or to a true "active" hydrocephalus. The purpose of this study is to analyze the CSF-dynamics in patients with PTV and, possibly, to identify parameters that correlate with prognosis. Methods: 15 patients with PTV were treated following this protocol: 1-frontal ventriculostomy (with Rickham reservoir); 2-CSF-dynamics evaluation; 3-ventriculo-peritoneal shunt. CSF dynamics evaluation was based on an intraventricular infusion test (performed three to five days after ventriculostomy). Outflow Resistance (R-out) and Intracranial Elastance Index (EI, i.e. the reciprocal of intracranial compliance) were calculated. Patients were classified according to response to shunt into: 1-fast responders: rapid clinical improvement, i.e. within days/one month from surgery; 2-slow responders: patients presenting little clinical improvement occurring after months (despite neurorehabilitation); 3-non responders: no clinical improvement. Results: Seven patients (46.7%) were classified as fast-responders, three patients were classified as slow-responders (20%) and five patients were classified as non-responders (33.3%). Opening CSF pressure was less than 15 mmHg for all patients. R-out (cut-off >10 mmHg/ml/min) had 100% sensitivity, 50% specificity, 100% negative predictive value and 63.6% positive predictive value. EI (cut-off value >0.3) had 100% specificity, 42.4% sensitivity, 100% positive predictive value and 66.7% negative predictive value. Conclusions: Based on these considerations, we can suggest that, for patients with normal pressure PTV, analysis of CSF dynamics could be of help in selecting patients for CSF-shunt. A combination of Intracranial Elastance and of R-out could help predicting shunt responsiveness.
AB - Objective: The management of post-traumatic ventriculomegaly (PTV) is controversial. This is due to the difficulty to determine whether PTV is related to an atrophic process or to a true "active" hydrocephalus. The purpose of this study is to analyze the CSF-dynamics in patients with PTV and, possibly, to identify parameters that correlate with prognosis. Methods: 15 patients with PTV were treated following this protocol: 1-frontal ventriculostomy (with Rickham reservoir); 2-CSF-dynamics evaluation; 3-ventriculo-peritoneal shunt. CSF dynamics evaluation was based on an intraventricular infusion test (performed three to five days after ventriculostomy). Outflow Resistance (R-out) and Intracranial Elastance Index (EI, i.e. the reciprocal of intracranial compliance) were calculated. Patients were classified according to response to shunt into: 1-fast responders: rapid clinical improvement, i.e. within days/one month from surgery; 2-slow responders: patients presenting little clinical improvement occurring after months (despite neurorehabilitation); 3-non responders: no clinical improvement. Results: Seven patients (46.7%) were classified as fast-responders, three patients were classified as slow-responders (20%) and five patients were classified as non-responders (33.3%). Opening CSF pressure was less than 15 mmHg for all patients. R-out (cut-off >10 mmHg/ml/min) had 100% sensitivity, 50% specificity, 100% negative predictive value and 63.6% positive predictive value. EI (cut-off value >0.3) had 100% specificity, 42.4% sensitivity, 100% positive predictive value and 66.7% negative predictive value. Conclusions: Based on these considerations, we can suggest that, for patients with normal pressure PTV, analysis of CSF dynamics could be of help in selecting patients for CSF-shunt. A combination of Intracranial Elastance and of R-out could help predicting shunt responsiveness.
KW - CSF dynamics
KW - CSF shunt
KW - Intracranial Elastance
KW - Outflow Resistance
KW - Post-traumatic hydrocephalus
KW - Post-traumatic ventriculomegaly
KW - Shunt responders
UR - http://www.scopus.com/inward/record.url?scp=84870516763&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84870516763&partnerID=8YFLogxK
U2 - 10.1016/j.clineuro.2012.04.012
DO - 10.1016/j.clineuro.2012.04.012
M3 - Article
C2 - 22595485
AN - SCOPUS:84870516763
VL - 115
SP - 49
EP - 53
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
SN - 0303-8467
IS - 1
ER -