Skip to main content

Advertisement

SpringerLink
Log in

Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure?

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

In patients with idiopathic normal pressure hydrocephalus (iNPH) and ventriculomegaly, examine whether there is a gradient in pulsatile intracranial pressure (ICP) from within the cerebrospinal fluid (CSF) of cerebral ventricles (ICPIV) to the subdural (ICPSD) compartment. We hypothesized that pulsatile ICP is higher within the ventricular CSF.

Methods

The material includes 10 consecutive iNPH patients undergoing diagnostic ICP monitoring as part of pre-operative work-up. Eight patients had simultaneous ICPIV and ICPSD signals, and two patients had simultaneous signals from the lateral ventricle (ICPIV) and the brain parenchyma (ICPPAR). Intracranial pulsatility was characterized by the wave amplitude, rise time, and rise time coefficient; static ICP was characterized by mean ICP.

Results

None of the patients demonstrated gradients in pulsatile ICP, that is, we found no evidence of higher pulsatile ICP within the CSF of the cerebral ventricles (ICPIV), as compared to either the subdural (ICPSD) compartment or within the brain parenchyma (ICPPAR). During ventricular infusion testing in one patient, the ventricular ICP (ICPIV) was artificially increased, but this increase in ICPIV produced no gradient in pulsatile ICP from the ventricular CSF (ICPIV) to the parenchyma (ICPPAR).

Conclusions

In this cohort of iNPH patients, we found no evidence of transmantle gradient in pulsatile ICP. The data gave no support to the hypothesis that pulsatile ICP is higher within the CSF of the cerebral ventricles (ICPIV) than within the subdural (ICPSD) compartment or the brain parenchyma (ICPPAR) in iNPH patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Adams RD, Fisher CM, Hakim S, Ojeman RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 273:117–126

    Article  CAS  PubMed  Google Scholar 

  2. Bering EA Jr (1962) Circulation of the cerebrospinal fluid. Demonstration of the choroid plexus as the generator of the force for flow of fluid and ventricular enlargement. J Neurosurg 19:405–413

    Article  PubMed  Google Scholar 

  3. Conner ES, Foley L, PMcL B (1984) Experimental normal-pressure hydrocephalus is accompanied by increased transmantle pressure. J Neurosurg 61:322–327

    Article  CAS  PubMed  Google Scholar 

  4. Di Rocco C, Pettorossi VE, Caldarelli M, Mancinelli R, Velardi F (1978) Communicating hydrocephalus induced by mechanically increased amplitude f the intraventricular cerebrospinal fluid pressure: experimental studies. Exp Neurol 59:40–52

    Article  PubMed  Google Scholar 

  5. Dutta-Roy T, Wittek A, Miller K (2008) Biomechanical modelling of normal pressure hydrocephalus. J Biomechanics 41:2263–2271

    Article  Google Scholar 

  6. Egnor M, Rosiello A, Zheng L (2001) A model of intracranial pulsations. Pediatr Neurosurg 35:284–298

    Article  CAS  PubMed  Google Scholar 

  7. Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303

    Article  PubMed  Google Scholar 

  8. Eide PK (2006) A new method for processing of continuous intracranial pressure signals. Med Eng Physics 28:579–587

    Article  Google Scholar 

  9. Eide PK (2006) Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients treated with ventriculo-peritoneal shunts. Acta Neurochir (Wien) 148:21–29

    Article  CAS  Google Scholar 

  10. Eide PK (2006) Comparison of simultaneous continuous intracranial pressure (ICP) signals from a Codman and a Camino ICP sensor. Med Eng Physics 28:542–549

    Article  Google Scholar 

  11. Eide PK, Sorteberg W, Meling T, Jörum E, Hald J, Stubhaug A (2007) From intracranial pressure to intracranial pressure wave-guided intensive care management of a patient with an aneurysmal subarachnoid hemorrhage. Acta Anaesthesiol Scand 51:501–504

    Article  CAS  PubMed  Google Scholar 

  12. Eide PK (2008) Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients. J Neurosurg 109:912–917

    Article  PubMed  Google Scholar 

  13. Eide PK, Sorteberg W (2010) Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients. Neurosurgery 66:80–91

    Article  PubMed  Google Scholar 

  14. Fishman RA (1966) Occult hydrocephalus. N Engl J Med 274:466–467

    Google Scholar 

  15. Guinane JE (1977) Why does hydrocephalus progress? J Neurol Sci 32:1–8

    Article  CAS  PubMed  Google Scholar 

  16. Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27:145–165

    PubMed  Google Scholar 

  17. Hoff J, Barber R (1974) Transcerebral mantle pressure in normal pressure hydrocephalus. Arch Neurol 31:101–105

    CAS  PubMed  Google Scholar 

  18. Madsen JR, Egnor M, Zou R (2006) Cerebrospinal fluid pulsatility and hydrocephalus: the fourth circulation. Clin Neurosurg 53:48–52

    PubMed  Google Scholar 

  19. Milhorat TH (1969) Choroid plexus and cerebrospinal fluid production. Science 166:1514–1516

    Article  CAS  PubMed  Google Scholar 

  20. O’Connel JEA (1943) The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation. Brain 66:204–228

    Article  Google Scholar 

  21. Peña A, Harris NG, Bolton MD, Czosnyka M, Pickard JD (2002) Communicating hydrocephalus: the biomechanics of progressive ventricular enlargement revisited. Acta Neurochir [Suppl] 81:59–63

    Google Scholar 

  22. Penn RD, Lee MC, Linninger AA, Miesel K, Lu SN, Stylos L (2005) Pressure gradients in the brain in an experimental model of hydrocephalus. J Neurosurg 102:1069–1075

    Article  PubMed  Google Scholar 

  23. Penn RD, Linninger AA (2009) The physics of hydrocephalus. Pediatr Neurosurg 45:161–174

    Article  PubMed  Google Scholar 

  24. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery 57:24–216

    Google Scholar 

  25. Shapiro K, Kohn IJ, Takei F, Zee C (1987) Progressive ventricular enlargement in cats in the absence of transmantle pressure gradients. J Neurosurg 67:88–92

    Article  CAS  PubMed  Google Scholar 

  26. Stephensen H, Tisell M, Wikkelsö C (2002) There is no transmantle pressure gradient in communicating or non-communicating hydrocephalus. Neurosurgery 50:763–773

    Article  PubMed  Google Scholar 

  27. Waugshul ME, Chen JJ, Egnor MR, McCormack EJ, Roche PE (2006) Amplitude and phase of cerebrospinal fluid pulsations: experimental studies and review of the literature. J Neurosurg 104:810–819

    Article  Google Scholar 

  28. Wilson CB, Bertan V (1967) Interruption of the anterior choroidal artery in experimental hydrocepalus. Arch Neurol 17:614–619

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors are grateful to Codman, Johnson & Johnson, Norway, for supporting us with Codman ICP sensors within external ventricular drains.

Conflicts of interest

The software used for analysis of the ICP recordings (Sensometrics Software) is manufactured by a software company (dPCom AS, Oslo, Norway) wherein Per Kristian Eide MD PhD has a financial interest. Terje Sæhle MD reports no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet HF, 0027, Oslo, Norway

    Per Kristian Eide & Terje Sæhle

Authors
  1. Per Kristian Eide
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Terje Sæhle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Per Kristian Eide.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eide, P.K., Sæhle, T. Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure?. Acta Neurochir 152, 989–995 (2010). https://doi.org/10.1007/s00701-010-0605-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-010-0605-x

Keywords

Search

Navigation