title: Vascular endothelial growth factor in the CSF of elderly patients with ventriculomegaly: variability, periodicity and levels in drainage responders and non-responders.
abstract: OBJECTIVE
  The aim of this study was to examine lumbar CSF-VEGF levels from elderly patients with ventriculomegaly to evaluate the possible circadian or periodic concentration profile and relevance to the prediction of drainage response.
  
  
  METHODS
  Lumbar CSF samples were collected in 1-h interval over 35 h from 22 patients with ventriculomegaly. CSF-VEGF levels were measured to elucidate the possible circadian or periodic concentration profiles. These VEGF levels were evaluated for correlations with clinical response to CSF drainage, ventricle size and other clinical information.
  
  
  RESULTS
  The 35-h CSF-VEGF levels demonstrated a periodic concentration pattern with significant episodic fluctuation with 3-5h intervals. CSF-VEGF levels in non-responder group in which patients did not show clinical improvement with CSF drainage were significantly higher than these in responder group.
  
  
  CONCLUSIONS
  VEGF variation in hydrocephalus patients suggests its possible pathophysiological role in hydrocephalus. The periodic concentration pattern of CSF-VEGF must be considered when choosing the most appropriate time for sample collection or clinical manipulation. Increased VEGF level in patients who showed no improvement with CSF drainage suggests that a possible greater ischemic or vascular injury may play a role in these patients. Pending further studies, these results suggest that high VEGF levels have a potential application in predicting non-responder patients with CSF drainage and so reducing the morbidity and cost of drainage and shunting in these patients.
authors: Department of Neurological Surgery, Section of Pediatric and Congenital Neurological Surgery, CSF Physiology Laboratory, Neurological Institute, Cleveland Clinic, S-60, 9500 Euclid Avenue, Cleveland 44195, USA.
authors: Jun
authors: J
authors: Yang
authors: Stephen M
authors: SM
authors: Dombrowski
authors: Chandra
authors: C
authors: Krishnan
authors: Natalie
authors: N
authors: Krajcir
authors: Abhishek
authors: A
authors: Deshpande
authors: Serge
authors: S
authors: El-Khoury
authors: Deepti Kamasamudram
authors: DK
authors: Guruprakash
authors: Mark G
authors: MG
authors: Luciano
mesh_terms: D000368:Aged; D002557:Cerebrospinal Fluid Shunts; D002940:Circadian Rhythm / Q000502:physiology*; D004322:Drainage; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000473:pathology / Q000628:therapy; D006850:Hydrocephalus, Normal Pressure / Q000134:cerebrospinal fluid / Q000469:parasitology; D007091:Image Processing, Computer-Assisted; D007118:Immunoassay; D008279:Magnetic Resonance Imaging; D008297:Male; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000134:cerebrospinal fluid*
chemical_list: D042461:Vascular Endothelial Growth Factor A
keywords: ANOVA; CBF; CSF; Circadian; Concentration; Continuous CSF sampling; ELISA; MRI; NPH; Periodic; Rcf; VEGF; cerebral blood flow; cerebrospinal fluid; enzyme-linked immunosorbent assay; magnetic resonance imaging; normal pressure hydrocephalus; one way analysis of variance; relative centrifugal force; vascular endothelial growth factor