Reinvestigation of CSF outflow resistance value in idiopathic normal pressure hydrocephalus--comparing epidural pressure monitoring with lumbar subarachnoid cerebrospinal fluid pressure monitoring

• Published in: Nō shinkei geka Vol. 33; no. 6; p. 579
• Main Authors: Takeuchi, Totaro, Goto, Hiromi, Izaki, Kenji, Kokubu, Kohei, Oda, Masaya, Sasanuma, Jin-ichi, Maeno, Kazushige, Kikuchi, Yasuhiro, Koizumi, Jin-ichi, Watanabe, Zen-ichiro, Ito, Yasunobu, Ohara, Hiroo, Kowada, Masayoshi, Watanabe, Kazuo
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-06-2005
• Subjects: Aged; Cerebrospinal Fluid Pressure - physiology; Epidural Space; Female; Humans; Hydrocephalus, Normal Pressure - physiopathology; Hydrocephalus, Normal Pressure - surgery; Intracranial Pressure - physiology; Lumbar Vertebrae; Male; Middle Aged; Monitoring, Physiologic; Ventriculoperitoneal Shunt
• ISSN: 0301-2603

To compare the cerebrospinal fluid (CSF) outflow resistance values (Ro) with epidural pressure (EDP) monitoring and lumbar subarachnoid CSF pressure (L-CSFP) monitoring.
The subjects were 14 patients with possible iNPH (age: 59-74 years old, ratio of male and female 8:6). All the patients were subjected to an infusion test by a single bolus injection method (1 ml/sec., deltaV: 5 ml, t2: 2 min) as prescribed in the Standard of SINPHONI. EDP was monitored by continuous monitoring and the L-CSFP values By intermittent simple glass tube method (SINPHONI) were measured simultaneously. The Ro (RoEDP, RoL-CSFP) calculated from both methods, (1) the correlation of Ro and (2) the Ro threshold in a shunt effective group (E: nine cases) and a non effective group (NE, five cases) were compared.
(1) Although a favorable correlation was found between both Ro measurements (r=0.784), the RoEDP was always higher than the RoL-CSFP. (2) The mean Ro values in the E and NE groups were 36.8 +/- 15.7 mmHg/ml/min, and 10 +/- 2.05 mmHg/ml/min for Ro-EDP, 22.1 +/- 13.95 mmg/ml/min and 6.4 +/- 1.7 mmHg/ml/min for RoL-CSFP, respectively. The approximate thresholds in the E and NE groups were 15 mmHg/ml/min for RoEDP and 10 mmHg/ml/min for RoL-CSFP.
(1) Although the RoEDP is always higher than the RoL-CSFP, a favorable correlation is found between the RoEDP and RoL-CSFP, (2) The Ro thresholds of the E and NE groups in the infusion test are about 15 mmHg/ml/min for RoEDP and 10 mmHg/ml/min for RoL-CSFP. (3) After this, Ro calculation ought to execute by standard of SINPHONI and the Ro threshold of the E and NE groups is about 10 mmHg/ml/min.