CSF dynamics analysis in patients with post-traumatic ventriculomegaly

• Published in: Clinical neurology and neurosurgery Vol. 115; no. 1; pp. 49 - 53
• Main Authors: De Bonis, Pasquale, Mangiola, Annunziato, Pompucci, Angelo, Formisano, Rita, Mattogno, Pierpaolo, Anile, Carmelo
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01-01-2013; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Biological and medical sciences; Brain damage; Brain Injuries - cerebrospinal fluid; Brain Injuries - physiopathology; Brain Injuries - surgery; Cerebrospinal fluid; Cerebrospinal Fluid Pressure - physiology; CSF dynamics; CSF shunt; Female; Head injuries; Humans; Hydrocephalus; Hydrocephalus - etiology; Hydrocephalus - physiopathology; Hydrocephalus - surgery; Intracranial Elastance; Male; Medical sciences; Middle Aged; Mortality; Neurology; Neurosurgery; Outflow Resistance; Post-traumatic hydrocephalus; Post-traumatic ventriculomegaly; Pressure; Prognosis; Rehabilitation; Sensitivity and Specificity; Shunt responders; Shunts; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Third Ventricle - physiopathology; Third Ventricle - surgery; Treatment Outcome; Ventriculoperitoneal Shunt - adverse effects; Ventriculostomy - adverse effects; Ventriculostomy - methods; Post-traumatic hydrocephalus; Shunt responders; CSF shunt; CSF dynamics; Intracranial Elastance; Outflow Resistance; Post-traumatic ventriculomegaly; Human; Intracranial; Nervous system diseases; Shunt; Cerebrospinal fluid; Trauma; Hydrodynamic drag; Cerebral disorder; Cerebral ventricular dilatation; Surgery; Central nervous system disease; Hydrocephaly
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.04.012

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.