Assessment of neurofluid dynamics in relation to clinical improvement after tap-test: pilot study.

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY Acta Neurochirurgica Pub Date : 2024-09-03 DOI:10.1007/s00701-024-06239-z

Julien Moyet, Olivier Baledent, Tomislav Slovenski, Pietro Todessayi, Serge Metanbou, Guillaume Deschasse, Frédéric Bloch, Cyrille Capel

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Abstract

Purpose: Idiopathic Normal pressure hydrocephalus (iNPH) is an under-diagnosed in elderly patients but none of the diagnostic tests are currently sufficiently sensitive or specific. The objective of this study was to analyze the dynamics of neurofluids by PC-MRI in relation to clinical evolution as measured using the iNPH grading scale after tap-test.

Method: We prospectively included patients with suspected iNPH. All these patients underwent PCMRI to assess craniospinal hemohydrodynamics with analysis of the stroke volume of the cephalospinal fluid (CSF) within the Sylvius' aqueduct, within the high cervical subarachnoid spaces and the arteriovenous stroke volume. By this means, we calculated a compliance index. Morphological analysis was carried out using the DESH score. The infusion test was measuring the resistance to CSF flow. We analysed all these parameters according to the clinical improvement of the patients.

Results: 23 patients were included. Compliance index assessed by PC-MRI was significantly higher in the group of patients with improvement > 10% (p = 0.015).

Conclusions: Our study highlights the importance of investigating arteriovenous and CSF interactions in iNPH. This involves understanding the physiological and pathophysiological mechanisms related to the circulation of neurofluids. The analysis of the interactions of these neurofluids allows for a comprehensive understanding of the system.

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评估神经流体动力学与敲击试验后临床改善的关系：试验研究。

目的：特发性正常压力脑积水（iNPH）是老年患者中诊断率较低的一种疾病，但目前没有一种诊断测试具有足够的敏感性或特异性。本研究的目的是通过 PC-MRI 分析神经流体的动态变化与临床演变的关系，临床演变是在拍击试验后使用 iNPH 分级表测量的：方法：我们前瞻性地纳入了疑似 iNPH 患者。所有这些患者都接受了 PCMRI 检查，通过分析西尔维乌斯导水管内、高颈椎蛛网膜下腔内的头椎管液（CSF）的冲流量和动静脉冲流量来评估颅椎管血流动力学。通过这种方法，我们计算出了顺应性指数。使用 DESH 评分进行形态学分析。输液试验测量的是脑脊液流动的阻力。我们根据患者的临床改善情况对所有这些参数进行了分析。通过 PC-MRI 评估的顺应性指数在病情改善大于 10% 的患者组中明显更高（P = 0.015）：我们的研究强调了研究 iNPH 中动静脉和脑脊液相互作用的重要性。结论：我们的研究强调了研究 iNPH 中动静脉和 CSF 相互作用的重要性，这涉及到了解与神经流体循环相关的生理和病理生理学机制。分析这些神经流体的相互作用有助于全面了解该系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.