Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure?
OBJECTIVE
In patients with idiopathic normal pressure hydrocephalus (iNPH) and ventriculomegaly, examine whether there is a gradient in pulsatile intracranial pressure (ICP) from within the cerebrospinal fluid (CSF) of cerebral ventricles (ICP(IV)) to the subdural (ICP(SD)) compartment. We hypothesized that pulsatile ICP is higher within the ventricular CSF.


METHODS
The material includes 10 consecutive iNPH patients undergoing diagnostic ICP monitoring as part of pre-operative work-up. Eight patients had simultaneous ICP(IV) and ICP(SD) signals, and two patients had simultaneous signals from the lateral ventricle (ICP(IV)) and the brain parenchyma (ICP(PAR)). Intracranial pulsatility was characterized by the wave amplitude, rise time, and rise time coefficient; static ICP was characterized by mean ICP.


RESULTS
None of the patients demonstrated gradients in pulsatile ICP, that is, we found no evidence of higher pulsatile ICP within the CSF of the cerebral ventricles (ICP(IV)), as compared to either the subdural (ICP(SD)) compartment or within the brain parenchyma (ICP(PAR)). During ventricular infusion testing in one patient, the ventricular ICP (ICP(IV)) was artificially increased, but this increase in ICP(IV) produced no gradient in pulsatile ICP from the ventricular CSF (ICP(IV)) to the parenchyma (ICP(PAR)).


CONCLUSIONS
In this cohort of iNPH patients, we found no evidence of transmantle gradient in pulsatile ICP. The data gave no support to the hypothesis that pulsatile ICP is higher within the CSF of the cerebral ventricles (ICP(IV)) than within the subdural (ICP(SD)) compartment or the brain parenchyma (ICP(PAR)) in iNPH patients.
Department of Neurosurgery, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet HF, 0027 Oslo, Norway. per.kristian.eide@rikshospitalet.no
Per Kristian
PK
Eide
Terje
T
Saehle
D000368:Aged; D000369:Aged, 80 and over; D002552:Cerebral Ventricles / Q000473:pathology* / Q000503:physiopathology*; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology* / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011673:Pulsatile Flow / Q000502:physiology*; D014057:Tomography, X-Ray Computed