Abstract:
OBJECTIVE:The decision for surgical intervention in hydrocephalic patients presenting with symptoms suggesting raised intracranial pressure (ICP) is challenging because radiographic ventricular size often lacks the specificity to predict abnormal ICP. An early assessment of the potential clinical usefulness of a noninvasive magnetic resonance imaging-based measurement of ICP (MR-ICP) in symptomatic hydrocephalic patients is reported. METHODS:Twenty-seven symptomatic hydrocephalic patients (18 with shunts and 9 without shunts) underwent brain magnetic resonance imaging-based studies that included measurements of cerebrospinal fluid and blood flows to and from the cranial vault, from which measurements of ICP were derived using a previously described algorithm. The predictive values of the MR-ICP measurement were determined on the basis of whether or not the patient underwent a surgical treatment of a shunt placement or shunt revision within a 3-month period after the magnetic resonance imaging-based study. RESULTS:MR-ICP values in these patients spanned a much wider range than in healthy control subjects. However, the majority of the patients (20 out of 26 patients) had MR-ICP values within the normal range. The short-term follow-up of patients who had normal MR-ICP measurement reveals that only one of the 20 patients required surgery. Consequently, the MR-ICP measurement has a strong negative predictive value (95% for all patients and 100% for patients without a shunt). CONCLUSION:A finding of a normal MR-ICP value in hydrocephalic patients presenting with symptoms suggestive of abnormal ICP is a strong predictor for resolution of symptoms or stable outcome without surgical intervention.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Glick RP,Niebruegge J,Lee SH,Egibor O,Lichtor T,Alperin Ndoi
10.1227/01.NEU.0000245586.23710.EFsubject
Has Abstractpub_date
2006-11-01 00:00:00pages
1052-60; discussion 1060-1issue
5eissn
0148-396Xissn
1524-4040pii
00006123-200611000-00010journal_volume
59pub_type
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