NDLI: Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery.

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Year: 2010 Volume: 112 Issue: 1

Year: 2009 Volume: 111

Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Eide, Per K. Stanisic, Milo
Description	Country affiliation: Norway Author Affiliation: Eide PK ( Department of Neurosurgery, Division of Clinical Neuroscience, Rikshospitalet University Hospital, Oslo, Norway. per.kristian.eide@rikshospitalet.no)
Abstract	OBJECT: This study was performed in patients with idiopathic normal-pressure hydrocephalus (iNPH) to monitor cerebral metabolism with microdialysis (MD) and intracranial pressure (ICP) readings, and relate to the clinical responses to extended lumbar drainage (ELD) and shunt surgery. METHODS: The baseline levels of MD metabolites and ICP were monitored overnight in 40 consecutive patients with iNPH. In a subset of 28 patients, monitoring was continued during 3 days of ELD. Thirty-one patients received a ventriculoperitoneal shunt. The clinical severity of iNPH was determined before and then 3 and 6-12 months after shunt surgery. RESULTS: Altered levels of MD markers (lactate, pyruvate, lactate/pyruvate ratio, glutamate, and/or glycerol) were seen in all patients at baseline; these improved during ELD. Despite normal static ICP (mean ICP), the pulsatile ICP (the ICP wave amplitude) was increased in 24 patients (60%). Only the level of the ICP wave amplitude differentiated the ELD and/or shunt responders from nonresponders. CONCLUSIONS: The MD monitoring indicated low-grade cerebral ischemia in patients with iNPH; during ELD, cerebral metabolism improved. The pulsatile ICP (the ICP wave amplitude) was the only variable differentiating the clinical responders from the nonresponders. The authors suggest that the pulsatile ICP reflects the intracranial compliance and that CSF diversion improves the biophysical milieu of the nerve cells, which subsequently may improve their biochemical milieu.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	2
Volume Number	112
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2010-02-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Brain Physiopathology Hydrocephalus, Normal Pressure Therapy Intracranial Pressure Microdialysis Monitoring, Physiologic Brain Ischemia Etiology Cerebrospinal Fluid Shunts Cohort Studies Drainage Complications Lumbar Vertebrae Severity Of Illness Index Time Factors
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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