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Intracranial Pressure & Neuromonitoring XVI pp 221–228Cite as

Ventriculomegaly in the Elderly: Who Needs a Shunt? A MRI Study on 90 Patients

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 126))

Abstract

Objective: In the case of ventriculomegaly in the elderly, it is often difficult to differentiate between communicating chronic hydrocephalus (CCH) and brain atrophy. The aim of this study is to describe the MRI criteria of CCH, defined by a symptomatic patient with ventriculomegaly and that improved after shunt placement.

Materials and methods: Magnetic resonance imaging was prospectively evaluated in 90 patients with ventriculomegaly. Patients were classified into three groups: patients without clinical signs of CCH (control, n = 47), patients with CCH treated by shunt placement with clinical improvement (responders, n = 36), and patients with CCH treated using a shunt without clinical improvement (nonresponders, n = 7). MRI parameters of the two groups of interest (responders vs. controls) were compared.

Results: Compared with controls, Evans’ index (p = 0.029), ventricular area (p < 0.01), and volume (p = 0.0001) were higher in the responders. In this group, the callosal angle was smaller (p ≤ 0.0001) and the aqueductal stroke volume (SVa) of CSF was higher (p ≤ 0.0001) than in controls. On the ROC curves, the optimal cut-off values for differentiating between responders and controls were a ventricular area >33.5 cm2, a callosal angle <90.8° and a SVa > 136.5 μL/R-R. In multivariate analysis, responders remained associated with SVa and callosal angle, with a c-statistic of 0.90 (95%CI, 0.83–0.98).

Conclusion: On suspicion of CCH, a large ventricular area, a small callosal angle, and an increased aqueductal stroke volume are important MRI arguments that can be associated with the clinical evaluation and dynamic testing of CSF to confirm the indication for a shunt.

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Acknowledgements

This prospective study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the ethics committee of Amiens University Hospital, where the full study protocol can be accessed (no ID RCB: 2011-A01633-38), with funds from the interregional clinical research hospital program (IR11).

Conflicts of interest statement

We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Neurosurgery, Lille University Hospital, Lille, France

    Marc Baroncini & Jean-Paul Lejeune

  2. Medical Imaging Unit, Amiens University Hospital, Amiens, France

    Olivier Balédent

  3. Neuroradiology, Lille University Hospital, Lille, France

    Celine Ebrahimi Ardi, Gregory Kuchcinski, Gustavo Soto Ares & Jérôme Hodel

  4. Lille University Hospital, EA 2694 – Santé publique: épidémiologie et qualité des soins, Lille, France

    Valerie Deken Delannoy & Alain Duhamel

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  1. Marc Baroncini
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  9. Jérôme Hodel
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Correspondence to Marc Baroncini .

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Editors and Affiliations

  1. Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Thomas Heldt

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Baroncini, M. et al. (2018). Ventriculomegaly in the Elderly: Who Needs a Shunt? A MRI Study on 90 Patients. In: Heldt, T. (eds) Intracranial Pressure & Neuromonitoring XVI. Acta Neurochirurgica Supplement, vol 126. Springer, Cham. https://doi.org/10.1007/978-3-319-65798-1_45

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  • DOI: https://doi.org/10.1007/978-3-319-65798-1_45

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  • Online ISBN: 978-3-319-65798-1

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