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Erschienen in: Acta Neurochirurgica 5/2018

08.03.2018 | Original Article - Neurosurgery Training

Validation of Davson’s equation in patients suffering from idiopathic normal pressure hydrocephalus

verfasst von: Afroditi-Despina Lalou, Virginia Levrini, Matthew Garnett, Eva Nabbanja, Dong-Joo Kim, Laurent Gergele, Anna Bjornson, Zofia Czosnyka, Marek Czosnyka

Erschienen in: Acta Neurochirurgica | Ausgabe 5/2018

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Abstract

Introduction

The so-called Davson’s equation relates baseline intracranial pressure (ICP) to resistance to cerebrospinal fluid outflow (Rout), formation of cerebrospinal fluid (If) and sagittal sinus pressure (PSS) There is a controversy over whether this fundamental equation is applicable in patients with normal pressure hydrocephalus (NPH). We investigated the relationship between Rout and ICP and also other compensatory, clinical and demographic parameters in NPH patients.

Method

We carried out a retrospective study of 229 patients with primary NPH who had undergone constant-rate infusion studies in our hospital. Data was recorded and processed using ICM+ software. Relationships between variables were sought by calculating Pearson product correlation coefficients and p values.

Results

We found a significant, albeit weak, relationship between ICP and Rout (R = 0.17, p = 0.0049), Rout and peak-to-peak amplitude of ICP (AMP) (R = 0.27, p = 3.577e-05) and Rout and age (R = 0.16, p = 0.01306).

Conclusions

The relationship found between ICP and Rout provides indirect evidence to support disturbed Cerebrospinal fluid circulation as a key factor in disturbed CSF dynamics in NPH. Weak correlation may indicate that other factors—variable PSS and formation of CSF outflow—contribute heavily to linear model expressed by Davson’s equation.
Literatur
1.
Zurück zum Zitat Adams RD, Fisher CM, Hakim S, Ojeman RG, Sweet W (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. N Engl J Med 273(3):117–126CrossRefPubMed Adams RD, Fisher CM, Hakim S, Ojeman RG, Sweet W (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. N Engl J Med 273(3):117–126CrossRefPubMed
3.
Zurück zum Zitat Andersson N, Malm J, Bäcklund T, Eklund A (2005) Assessment of cerebrospinal fluid outflow conductance using constant-pressure infusion—a method with real time estimation of reliability. Physiol Meas 26(6):1137–1148CrossRefPubMed Andersson N, Malm J, Bäcklund T, Eklund A (2005) Assessment of cerebrospinal fluid outflow conductance using constant-pressure infusion—a method with real time estimation of reliability. Physiol Meas 26(6):1137–1148CrossRefPubMed
4.
Zurück zum Zitat Bech-Azeddine R, Gjerris F, Waldemar G, Czosnyka M, Juhler M (2005) Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochir 147(10):1027–1036CrossRefPubMed Bech-Azeddine R, Gjerris F, Waldemar G, Czosnyka M, Juhler M (2005) Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochir 147(10):1027–1036CrossRefPubMed
5.
Zurück zum Zitat Bech RA, Juhler M, Waldemar G, Klinken L, Gjerris F (1997) Frontal brain and leptomeningeal biopsy specimens correlated with cerebrospinal fluid outflow resistance and B-wave activity in patients suspected of normal-pressure hydrocephalus. Neurosurgery 40(3):497–502PubMed Bech RA, Juhler M, Waldemar G, Klinken L, Gjerris F (1997) Frontal brain and leptomeningeal biopsy specimens correlated with cerebrospinal fluid outflow resistance and B-wave activity in patients suspected of normal-pressure hydrocephalus. Neurosurgery 40(3):497–502PubMed
6.
Zurück zum Zitat Bellur SN, Chandra V, McDonald LW (1980) Arachnoidal cell hyperplasia. Its relationship to aging and chronic renal failure. Arch Pathol Lab Med 104(8):414–416PubMed Bellur SN, Chandra V, McDonald LW (1980) Arachnoidal cell hyperplasia. Its relationship to aging and chronic renal failure. Arch Pathol Lab Med 104(8):414–416PubMed
7.
Zurück zum Zitat Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87(5):687–693CrossRefPubMed Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87(5):687–693CrossRefPubMed
8.
Zurück zum Zitat Boon AJW, Tans JTJ, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HAL, Hermans J (2000) The Dutch normal-pressure hydrocephalus study. How to select patients for shunting? An analysis of four diagnostic criteria Surg Neurol 53(3):201–207PubMed Boon AJW, Tans JTJ, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HAL, Hermans J (2000) The Dutch normal-pressure hydrocephalus study. How to select patients for shunting? An analysis of four diagnostic criteria Surg Neurol 53(3):201–207PubMed
9.
Zurück zum Zitat Børgesen SE, Albeck MJ, Gjerris F, Czosnyka M, Laniewski P (1992) Computerized infusion test compared to steady pressure constant infusion test in measurement of resistance to CSF outflow. Acta Neurochir 119(1–4):12–16CrossRefPubMed Børgesen SE, Albeck MJ, Gjerris F, Czosnyka M, Laniewski P (1992) Computerized infusion test compared to steady pressure constant infusion test in measurement of resistance to CSF outflow. Acta Neurochir 119(1–4):12–16CrossRefPubMed
10.
Zurück zum Zitat Brgesen SE, Gjerris FLEMMING (1982) The predictive value of conductance to outflow of CSF in Normal pressure hydrocephalus. Brain J Neurol 105(Pt1):65-86 Brgesen SE, Gjerris FLEMMING (1982) The predictive value of conductance to outflow of CSF in Normal pressure hydrocephalus. Brain J Neurol 105(Pt1):65-86
12.
Zurück zum Zitat Czosnyka M, Czosnyka Z, Momjian S, Pickard JD (2004) Cerebrospinal fluid dynamics. Physiol Meas 25(5):R51–R76CrossRefPubMed Czosnyka M, Czosnyka Z, Momjian S, Pickard JD (2004) Cerebrospinal fluid dynamics. Physiol Meas 25(5):R51–R76CrossRefPubMed
13.
Zurück zum Zitat Czosnyka M, Czosnyka ZH, Whitfield PC, Donovan T, Pickard JD (2001) Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg 94(3):482–486CrossRefPubMed Czosnyka M, Czosnyka ZH, Whitfield PC, Donovan T, Pickard JD (2001) Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg 94(3):482–486CrossRefPubMed
14.
Zurück zum Zitat Eide P, Fremming A, Sorteberg A (2003) Lack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand 108(14):381–388CrossRefPubMed Eide P, Fremming A, Sorteberg A (2003) Lack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand 108(14):381–388CrossRefPubMed
15.
Zurück zum Zitat Ekstedt JAN (1978) CSF hydrodynamic studies in man. J Neurol Psychiatry 41:345–353CrossRef Ekstedt JAN (1978) CSF hydrodynamic studies in man. J Neurol Psychiatry 41:345–353CrossRef
16.
Zurück zum Zitat Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2(4):307–327CrossRefPubMed Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2(4):307–327CrossRefPubMed
17.
Zurück zum Zitat Kahlon B, Sundbärg G, Rehncrona S (2002) Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 73(6):721–726CrossRefPubMedPubMedCentral Kahlon B, Sundbärg G, Rehncrona S (2002) Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 73(6):721–726CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Kalyvas A V, Hughes M, Koutsarnakis C, Moris D, Liakos F, Sakas DE, Stranjalis G, Fouyas I (2017) Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature. Acta Neurochir 33–49 Kalyvas A V, Hughes M, Koutsarnakis C, Moris D, Liakos F, Sakas DE, Stranjalis G, Fouyas I (2017) Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature. Acta Neurochir 33–49
19.
Zurück zum Zitat Kim D-J, Kim H, Kim Y-T, Yoon BC, Czosnyka Z, Park K-W, Czosnyka M (2015) Thresholds of resistance to CSF outflow in predicting shunt responsiveness. Neurol Res 37(4):332–340CrossRefPubMed Kim D-J, Kim H, Kim Y-T, Yoon BC, Czosnyka Z, Park K-W, Czosnyka M (2015) Thresholds of resistance to CSF outflow in predicting shunt responsiveness. Neurol Res 37(4):332–340CrossRefPubMed
20.
Zurück zum Zitat Lalou AD, Czosnyka M, Donnelly J, Pickard JD, Garnett MR, Nabbanja E, Keong NC, Czosnyka Z (2017) Cerebral autoregulation, its relationship with Rout and outcome after CSF diversion in normal pressure hydrocephalus. J Neurosurg. https://doi.org/10.1101/223867 Lalou AD, Czosnyka M, Donnelly J, Pickard JD, Garnett MR, Nabbanja E, Keong NC, Czosnyka Z (2017) Cerebral autoregulation, its relationship with Rout and outcome after CSF diversion in normal pressure hydrocephalus. J Neurosurg. https://​doi.​org/​10.​1101/​223867
21.
Zurück zum Zitat Meier U, Miethke C (2003) Predictors of outcome in patients with normal-pressure hydrocephalus. J Clin Neurosci 10(4):453–459CrossRefPubMed Meier U, Miethke C (2003) Predictors of outcome in patients with normal-pressure hydrocephalus. J Clin Neurosci 10(4):453–459CrossRefPubMed
22.
Zurück zum Zitat Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 127(pt5):965–972 Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 127(pt5):965–972
23.
Zurück zum Zitat Nabbanja E, Czosnyka M, Keong NC, Garnett MR, Pickard JD, Lalou AD CZI (2018) Is there a link between ICP-derived infusion test parameters and outcome after shunting in NPH? In: Heldt T (ed) Intracranial pressure & neuromonitoring XVI. Acta Neurochir Suppl. https://doi.org/10.1007/978-3-319-65798-1 Nabbanja E, Czosnyka M, Keong NC, Garnett MR, Pickard JD, Lalou AD CZI (2018) Is there a link between ICP-derived infusion test parameters and outcome after shunting in NPH? In: Heldt T (ed) Intracranial pressure & neuromonitoring XVI. Acta Neurochir Suppl. https://​doi.​org/​10.​1007/​978-3-319-65798-1
24.
25.
Zurück zum Zitat Pickard J (1988) Physiology and pathophysiology of the cerebrospinal fluid. J Neurol Neurosurg Psychiatry 51(3):469–470CrossRefPubMedCentral Pickard J (1988) Physiology and pathophysiology of the cerebrospinal fluid. J Neurol Neurosurg Psychiatry 51(3):469–470CrossRefPubMedCentral
26.
Zurück zum Zitat Smielewski P, Czosnyka M, Zabolotny W, Kirkpatrick P, Richards H, Pickard JD (1997) A computing system for the clinical and experimental investigation of cerebrovascular reactivity. Int J Clin Monit Comput 14(3):185–198CrossRefPubMed Smielewski P, Czosnyka M, Zabolotny W, Kirkpatrick P, Richards H, Pickard JD (1997) A computing system for the clinical and experimental investigation of cerebrovascular reactivity. Int J Clin Monit Comput 14(3):185–198CrossRefPubMed
27.
Zurück zum Zitat Sundström N, Andersson K, Marmarou A, Malm J, Eklund A (2010) Comparison between 3 infusion methods to measure cerebrospinal fluid outflow conductance. J Neurosurg 113(6):1294–1303CrossRefPubMed Sundström N, Andersson K, Marmarou A, Malm J, Eklund A (2010) Comparison between 3 infusion methods to measure cerebrospinal fluid outflow conductance. J Neurosurg 113(6):1294–1303CrossRefPubMed
28.
Zurück zum Zitat Wikkelsø C, Hellström P, Klinge P et al (2013) The European iNPH multicentre study on the predictive values of resistance to CSF outflow and the CSF tap test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84(5):562–568CrossRefPubMed Wikkelsø C, Hellström P, Klinge P et al (2013) The European iNPH multicentre study on the predictive values of resistance to CSF outflow and the CSF tap test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84(5):562–568CrossRefPubMed
Metadaten
Titel
Validation of Davson’s equation in patients suffering from idiopathic normal pressure hydrocephalus
verfasst von
Afroditi-Despina Lalou
Virginia Levrini
Matthew Garnett
Eva Nabbanja
Dong-Joo Kim
Laurent Gergele
Anna Bjornson
Zofia Czosnyka
Marek Czosnyka
Publikationsdatum
08.03.2018
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 5/2018
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-018-3497-9

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