The role of cerebral blood flow and cerebrovascular reserve capacity in the diagnosis of chronic hydrocephalus--a PET-study on 60 patients.
To investigate the clinical value of cerebral blood flow (CBF) and cerebrovascular reserve capacity (CVR) in the management of chronic hydrocephalus. Global cortical CBF and CVR in 60 patients (66 +/- 12 yrs) with chronic hydrocephalus were investigated before, one week (7 d) and 7 months (7 m) after shunting by 15-O-H2O PET (Siemens ECAT 951/31) at rest and after application of acetazolamide (1 g). After 7 months, clinical outcome was assessed according to Stein and Langfitt and patients were classified into responder (n = 31) and non-responder (n = 29). Before Surgery, responder had lower blood flow values compared to non responder (36 +/- 8 vs. 41 +/- 11 ml/100 ml/min; p = 0.04), whereas CVR was not different between outcome groups (33 +/- 10 vs. 41 +/- 8%; p > 0.05). After shunting, CVR in non-responder decreased from 41 +/- 8% to 32 +/- 5% (7 d), whereas in responder significant increases (p < 0.02) to 55 +/- 46% (7 d) and 54 +/- 31% (7 m) were observed. Regarding early individual changes in CVR, the majority (12/18; 66%) of non-responder had marked decreases in CVR-levels (< 30%), whereas clinical responder considerably improved in CVR (> 30%) in half of patients (7/14). Measurement of cerebral blood flow in chronic hydrocephalus might substantially contribute to selection of shunt candidates and neurological sequels may be rather related to early regeneration of the hemodynamic reserve.
Klinge
P
P
Department of Neurosurgery, Medical School Hannover, Germany.
Berding
G
G
Brinker
T
T
Schuhmann
M
M
Weckesser
E
E
Knapp
W H
WH
Samii
M
M
D000086:Acetazolamide; D001783:Blood Flow Velocity; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D010104:Oxygen Radioisotopes; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D014655:Vascular Resistance
D010104:Oxygen Radioisotopes; D000086:Acetazolamide