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.
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References
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
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
Conner ES, Foley L, PMcL B (1984) Experimental normal-pressure hydrocephalus is accompanied by increased transmantle pressure. J Neurosurg 61:322–327
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
Dutta-Roy T, Wittek A, Miller K (2008) Biomechanical modelling of normal pressure hydrocephalus. J Biomechanics 41:2263–2271
Egnor M, Rosiello A, Zheng L (2001) A model of intracranial pulsations. Pediatr Neurosurg 35:284–298
Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303
Eide PK (2006) A new method for processing of continuous intracranial pressure signals. Med Eng Physics 28:579–587
Eide PK (2006) Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients treated with ventriculo-peritoneal shunts. Acta Neurochir (Wien) 148:21–29
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
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
Eide PK (2008) Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients. J Neurosurg 109:912–917
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
Fishman RA (1966) Occult hydrocephalus. N Engl J Med 274:466–467
Guinane JE (1977) Why does hydrocephalus progress? J Neurol Sci 32:1–8
Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27:145–165
Hoff J, Barber R (1974) Transcerebral mantle pressure in normal pressure hydrocephalus. Arch Neurol 31:101–105
Madsen JR, Egnor M, Zou R (2006) Cerebrospinal fluid pulsatility and hydrocephalus: the fourth circulation. Clin Neurosurg 53:48–52
Milhorat TH (1969) Choroid plexus and cerebrospinal fluid production. Science 166:1514–1516
O’Connel JEA (1943) The vascular factor in intracranial pressure and the maintenance of the cerebrospinal fluid circulation. Brain 66:204–228
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
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
Penn RD, Linninger AA (2009) The physics of hydrocephalus. Pediatr Neurosurg 45:161–174
Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery 57:24–216
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
Stephensen H, Tisell M, Wikkelsö C (2002) There is no transmantle pressure gradient in communicating or non-communicating hydrocephalus. Neurosurgery 50:763–773
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
Wilson CB, Bertan V (1967) Interruption of the anterior choroidal artery in experimental hydrocepalus. Arch Neurol 17:614–619
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.
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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
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DOI: https://doi.org/10.1007/s00701-010-0605-x