Regional cerebral blood flow profiles of shunt-responder in idiopathic chronic hydrocephalus--a 15-O-water PET-study.
To find out if regional characteristics of cerebral blood flow (CBF) and cerebrovascular reserve capacity (CVR) may indicate shunt response in idiopathic chronic hydrocephalus. 11 patients with idiopathic chronic hydrocephalus (65 +/- 13 yrs) were followed-up within a year after shunting. Patients were classified into clinical responder (n = 5) and non-responder (n = 6) according to Stein and Langfitt. All patients had measurement of CBF and CVR with dynamic 15-O-water PET (Siemens ECAT 951/31) before and after application of acetazolamide (1 g). Regional differences between outcome groups were analysed with "statistical Parametric Mapping" (SPM99b; Wellcome Department, London, UK). Group differences were regarded as significant, when uncorrected p-value on voxel and on cluster level were p < 0.001 and p < 0.05, respectively. Regarding CBF distribution there was significantly reduced CBF in the frontobasal cortex in responder compared to non-responder (cluster level p = 0.026). In CVR, a variety of cortical regions showed significant decreases compared with non-responder: also in frontobasal cortex (on cluster level p = 0.009). However, most significant reductions were found in temporodorsal and limbic cortical regions (on cluster level p < 0.001). Preoperative hemodynamics displayed a regional profile of reduced CBF and CVR in patients with shunt improvement. Prospective studies for determining the accuracy of regional blood flow characteristics for outcome prediction are warranted.
Klinge
P
P
Department of Neurosurgery, Medical School Hannover, Germany.
Berding
G
G
Brinker
T
T
Weckesser
E
E
Knapp
W H
WH
Samii
M
M
D000368:Aged; D001921:Brain / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010104:Oxygen Radioisotopes; D012039:Regional Blood Flow; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
D010104:Oxygen Radioisotopes