title: The lack of relationship between intracranial pressure and cerebral ventricle indices based on brain computed tomography in patients undergoing ventriculoperitoneal shunt.
abstract: BACKGROUND
  In this study we investigated whether cerebral ventricle indices based on brain computed tomography (CT) scans are reliable for predicting intracranial pressure (ICP) in hydrocephalic patients.
  
  
  METHODS
  Electronic medical records of 221 patients undergoing ventriculoperitoneal shunt due to hydrocephalus were retrospectively reviewed. Cerebral ventricle indices including Evans' index, third ventricle index, cella media index, and ventricular score were calculated from transverse diameters measured at various levels on preoperative brain CT scans. ICP was considered as CSF opening pressure. Patients were categorized into three groups: communicating hydrocephalus, non-communicating hydrocephalus, and normal pressure hydrocephalus (NPH). The non-communicating hydrocephalus group was further divided according to the obstruction site; aqueduct, fourth ventricle outlet, third ventricle, and the foramen of Monro. The primary endpoint was the extent of the correlation between cerebral ventricle indices and ICP in each hydrocephalus group.
  
  
  RESULTS
  No cerebral ventricle index correlated with ICP in patients with communicating hydrocephalus (n = 113) and NPH (n = 62). In the non-communicating hydrocephalus group (n = 46), only the third ventricle index revealed moderate negative correlation with ICP (r = -0.395, p < 0.01). In subgroup analyses, the third ventricle index showed a strong negative relationship with ICP only in patients with the third ventricle obstruction (r = -0.779, p < 0.05).
  
  
  CONCLUSIONS
  In this study we showed that although an inverse correlation existed between ICP and the third ventricle index only in patients with non-communicating hydrocephalus due to obstruction of the third ventricle, cerebral ventricle indices based on brain CT scan were non-reliable predictors of ICP in hydrocephalic patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, South Korea.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kim
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Lim
authors.forename: Han-Seul
authors.initials: HS
authors.lastname: Park
authors.forename: Sung-Kwon
authors.initials: SK
authors.lastname: Kim
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Lee
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles / Q000473:pathology*; D014695:Cerebral Ventriculography; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt