Clinical proof of the importance of compliance for hydrocephalus pathophysiology.
BACKGROUND
Recently decreased compliance is discussed as an initially disturbed CSF hydrodynamic parameter in hydrocephalus.


METHODS
In 180 patients with suspected chronic hydrocephalus we performed a dynamic infusion test, which was not used for shunt indication. Shunt indication was based on long-term ICP monitoring. Follow-up was 4.6 +/- 1.8 years.


METHODS
Spearman-, Kruskal-Wallis-, Wilcoxen-U-test.


RESULTS
Resistance to outflow (Rout) and Pressure Volume Index (PVI) alone provide positive predictive values (PPV) and sensitivity, which might be sufficient in daily practice, while negative predictive values (NPV) and specificity are weak. With an intelligent combined algorithm of Rout and PVI at a critical value of ROF of 13 mm Hg/ml x min and 30 ml, a clearly improved outcome prediction is possible.


CONCLUSIONS
These clinical results support recent opinions concerning the meaning of Compliance and Rout in hydrocephalus patho-physiology.
Kiefer
Michael
M
Department of Neurosurgery, Saarland University Medical School, Homburg-Saar, Germany. Michael.Kiefer@uks.eu
Eymann
Regina
R
D000465:Algorithms; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003187:Compliance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000503:physiopathology / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity