title: Changes in the volumes of the brain and cerebrospinal fluid spaces after shunt surgery in idiopathic normal-pressure hydrocephalus.
abstract: OBJECTIVE
  To investigate volumetric changes of the brain and cerebrospinal fluid (CSF) spaces after shunt surgery in shunt-responsive idiopathic normal-pressure hydrocephalus (iNPH), and correlations between the changes and postoperative clinical improvements.
  
  
  METHODS
  Twenty-one patients with shunt-responsive iNPH were studied. Magnetic resonance imaging (MRI) of the brain was performed before and 1year after surgery, and clinical symptoms were assessed by the iNPH Grading Scale, a validated assessment tool of the triad of iNPH, the Modified Rankin Scale, the Timed Up and Go Test, and neuropsychological tests including the Mini-Mental State Examination. The volumes of the left cerebral hemisphere, infratentorial brain, ventricles, and suprasylvian and infrasylvian subarachnoid CSF spaces were measured using an MRI-based volumetric technique.
  
  
  RESULTS
  The volumes of the cerebral hemisphere and infratentorial brain did not change significantly after shunt surgery (p=0.231, 0.109, respectively). The volumes of the ventricles and infrasylvian subarachnoid CSF spaces were significantly decreased (p<0.0001, <0.05, respectively), with a mean change rate of -26.1% and -4.5%, respectively. The volumes of the suprasylvian subarachnoid CSF spaces increased significantly (p<0.0001), with a mean change rate of 43.5%. The decrease in ventricular volumes was significantly correlated with clinical improvement.
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan. khiraoka@mail.tains.tohoku.ac.jp
authors.forename: Kotaro
authors.initials: K
authors.lastname: Hiraoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamasaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Takagi
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nishio
authors.forename: Osamu
authors.initials: O
authors.lastname: Iizuka
authors.forename: Shigenori
authors.initials: S
authors.lastname: Kanno
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Takeo
authors.initials: T
authors.lastname: Kondo
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000134:cerebrospinal fluid* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000134:cerebrospinal fluid* / Q000473:pathology*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*