BACKGROUND: Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients. METHODS: We retrospectively reviewed charts and MRI of 38 shunted patients (72,16 ±6,16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by T-test for baseline values and with repeated measures analysis of variance. RESULTS: 26 patients (68,4 %) improved after VPS (mean time of symptom onset was 8,15 ±7,19 months). Mean preoperative ACSV value was 271,85 ± 143,03, which decreased by 21,6 % (mean 213 ± 125,14 ) at the first month and 40,3% sixth months after VPS (mean 162,15 ± 91,5). 12 patients (31,6 %) did not improve (mean time of symptom onset was 29 ± 5,62 months). Mean preoperative ACSV value was 79,83 ± 31,24, decreased to 8,7 % (mean 72,83 ±28,66 ) at first month after VPS, 21,2% (mean 62,83 ± 31,12 ) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (p<0,01), onset time of symptoms (p<0,01) and the changes in ACSV after one and six months in both groups (p<0,001). CONCLUSIONS: ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment.
Quantitative analysis of cerebrospinal fluid dynamics at phase contrast cine-MRI: predictivity of neurosurgical "Shunt" responsiveness in patients with idiopathic normal pressure hydrocephalus
Stecco, Alessandro;Cassarà, Alessia;ZUCCALA', Alberto;ANOAICA, MIHAELA BIANCA;Guzzardi, Giuseppe;Carriero, Alessandro
2017-01-01
Abstract
BACKGROUND: Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients. METHODS: We retrospectively reviewed charts and MRI of 38 shunted patients (72,16 ±6,16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by T-test for baseline values and with repeated measures analysis of variance. RESULTS: 26 patients (68,4 %) improved after VPS (mean time of symptom onset was 8,15 ±7,19 months). Mean preoperative ACSV value was 271,85 ± 143,03, which decreased by 21,6 % (mean 213 ± 125,14 ) at the first month and 40,3% sixth months after VPS (mean 162,15 ± 91,5). 12 patients (31,6 %) did not improve (mean time of symptom onset was 29 ± 5,62 months). Mean preoperative ACSV value was 79,83 ± 31,24, decreased to 8,7 % (mean 72,83 ±28,66 ) at first month after VPS, 21,2% (mean 62,83 ± 31,12 ) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (p<0,01), onset time of symptoms (p<0,01) and the changes in ACSV after one and six months in both groups (p<0,001). CONCLUSIONS: ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
