title: Early brain perfusion improvement after ventriculoperitoneal shunt surgery in patients with idiopathic normal pressure hydrocephalus evaluated by 99mTc-HMPAO SPECT - preliminary report.
abstract: BACKGROUND
  Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-existing abnormalities. The most popular treatment option is surgical implantation of a shunt. Brain perfusion increase occurring months or years after successful shunt surgery is well described in the literature. Early improvement of perfusion is not well documented. Therefore, the objective of the present study was to determine patterns of brain perfusion changes 3-6 days after the ventriculoperitoneal shunting in patients with iNPH by using 99mTc-HMPAO SPECT.
  
  
  METHODS
  Sixteen patients with iNPH (9 women, 7 men, mean age 64.1 ± 12.7 years) who underwent ventriculoperitoneal shunt surgery were included into the study group. Indications for implanting a shunt were based on clinical history, neuroimaging and CSF dynamic studies with an infusion test. Brain perfusion SPECT was performed 1-2 days before and 3-6 days after the surgical treatment. For comparison of perfusion before and after the surgery SPECT scans were assessed visually and semiquantitatively with voxel based analysis.
  
  
  RESULTS
  No side effects were observed after the surgery. Brain perfusion improvement after shunting was observed in 10 patients (62.5%). Patterns of perfusion changes varied between patients, with combinations of different bilateral and lateralized brain regions involved. Perfusion increased in the whole brain (3 patients), in the right cerebral hemisphere (1 patient) or in the separate cerebral regions (6 patients): frontal, parietal, temporal, cerebellum, cingulate gyrus. Perfusion improvement was predominantly observed in the frontal lobes: right frontal (3 cases, 18.8%), left frontal (3 cases, 18.8%).
  
  
  CONCLUSIONS
  Cerebral perfusion is recovered promptly after ventriculoperitoneal shunt surgery in about 60% of patients with iNPH. This improvement may be global or regional in different cerebral areas with prevalence of the frontal lobes.
authors: Department of Nuclear Medicine, Medical University of Lublin, Poland. ampolak@o2.pl.
authors: Anna
authors: A
authors: Nocuń
authors: Anna
authors: A
authors: Mosiewicz
authors: Robert
authors: R
authors: Kaczmarczyk
authors: Teresa
authors: T
authors: Kazalska
authors: Elżbieta
authors: E
authors: Czekajska-Chehab
authors: Beata
authors: B
authors: Chrapko
authors: Tomasz
authors: T
authors: Trojanowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D017287:Ventriculoperitoneal Shunt
chemical_list: D019690:Technetium Tc 99m Exametazime