Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery

Clinical article

Per K. Eide M.D., Ph.D. and Milo Stanisic M.D., Ph.D.
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  • Department of Neurosurgery, Division of Clinical Neuroscience, Rikshospitalet University Hospital, Oslo, Norway
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Object

This study was performed in patients with idiopathic normal-pressure hydrocephalus (iNPH) to monitor cerebral metabolism with microdialysis (MD) and intracranial pressure (ICP) readings, and relate to the clinical responses to extended lumbar drainage (ELD) and shunt surgery.

Methods

The baseline levels of MD metabolites and ICP were monitored overnight in 40 consecutive patients with iNPH. In a subset of 28 patients, monitoring was continued during 3 days of ELD. Thirty-one patients received a ventriculoperitoneal shunt. The clinical severity of iNPH was determined before and then 3 and 6–12 months after shunt surgery.

Results

Altered levels of MD markers (lactate, pyruvate, lactate/pyruvate ratio, glutamate, and/or glycerol) were seen in all patients at baseline; these improved during ELD. Despite normal static ICP (mean ICP), the pulsatile ICP (the ICP wave amplitude) was increased in 24 patients (60%). Only the level of the ICP wave amplitude differentiated the ELD and/or shunt responders from nonresponders.

Conclusions

The MD monitoring indicated low-grade cerebral ischemia in patients with iNPH; during ELD, cerebral metabolism improved. The pulsatile ICP (the ICP wave amplitude) was the only variable differentiating the clinical responders from the nonresponders. The authors suggest that the pulsatile ICP reflects the intracranial compliance and that CSF diversion improves the biophysical milieu of the nerve cells, which subsequently may improve their biochemical milieu.

Abbreviations used in this paper: CBF = cerebral blood flow; ELD = extended lumbar drainage; ICP = intracranial pressure; iNPH = idiopathic normal-pressure hydrocephalus; L/P = lactate/pyruvate; MD = microdialysis; NPV = negative predictive value; PPV = positive predictive value.

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Contributor Notes

Address correspondence to: Per Kristian Eide, M.D., Ph.D., Department of Neurosurgery, Division of Clinical Neuroscience, Rikshospitalet University Hospital, N-0027 Oslo, Norway. email: per.kristian.eide@rikshospitalet.no.

Please include this information when citing this paper: published online June 19, 2009; DOI: 10.3171/2009.5.JNS09122.

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