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Clinical Research
Available online 18 February 2024
Usefulness of third ventricle volumetry in patients with normal pressure hydrocephalus
Utilidad de la volumetría del tercer ventrículo en pacientes con hidrocefalia a presión normal
Herbert Daniel Jiméne Zapata
Corresponding author
danijz88@gmail.com

Corresponding author.
, Adrián Fernández García, Carla Timisoara Amilburu Sáenz, Carlos Alberto Rodríguez Arias
Servicio de Neurocirugía, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Tables (2)
Table 1. NPH scale for the clinical assessment of patients with normal-pressure hydrocephalus.
Table 2. Tests available for selecting NPH patients who are candidates for VPS.
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Abstract
Objective

To use third ventricle morphometric variables as a tool for the selection of patients with idiopathic normal pressure hydrocephalus (iNPH) who are candidates for ventriculoperitoneal shunts (VPS).

Material and methods

Retrospective study enrolling patients with iNPH. Katzman infusion test was performed and a Rout > 12 mmHg/mL/min was considered a positive result. The transverse diameter and the volume of the third ventricle were measured in the preoperative MRI. Postoperative improvement was assessed with the NPH score. The results were analysed with SPSS software.

Results

52 patients with a mean age of 76 years were analysed. There was no difference in the diameter of the third ventricle among patients with a positive result and those with a negative result in the infusion test (12.28 vs 11.68 mm; p = 0.14). Neither were difference detected in the ventricle volume of both groups (3.6 vs 3.5cc; p = 0.66). Those patients who improved after VPS had a smaller third ventricle compared to those who did not respond after surgery (11.85 mm vs. 12.96 mm; p = 0.009). Diameter and volume of third ventricle present a significant strong correlation (Pearson correlation coefficient = 0.72; p < 0.0001).

Conclusion

Morphometric variables of third ventricle may be useful in predicting a good response to VPS in patients with idiopathic normal pressure hydrocephalus.

Keywords:
Normal pressure hydrocephalus
Third ventricle
Cerebrospinal fluid
Ventriculoperitoneal shunt
Resumen
Objetivos

Utilizar parámetros relacionados con el tamaño del tercer ventrículo como herramienta para la selección de pacientes con hidrocefalia a presión normal idiopática (HPNi) candidatos a derivación ventrículoperitoneal (DVP).

Material y métodos

Estudio retrospectivo basado en una serie de pacientes con sospecha de HPNi. Se les realizó un test de infusión de Katzman y se consideró resultado positivo una Rout >12 mmHg/mL/min. En todos ellos se midió el diámetro transverso y el volumen del tercer ventrículo en la resonancia prequirúrgica. Se valoró el grado de mejoría postoperatoria utilizando la escala NPH. Los datos fueron analizados con el programa SPSS.

Resultados

Se analizaron un total de 52 pacientes con una edad media de 76 años. No hubo diferencias en el diámetro del tercer ventrículo entre los pacientes con resultado positivo y aquellos con resultado negativo en el test de infusión (12,28 vs 11,68 mm; p = 0,14). Tampoco se detectaron diferencias en el volumen ventricular de ambos grupos (3,6 vs 3,5cc; p = 0,66). Aquellos pacientes que mejoraron tras la DVP presentaban un tercer ventrículo de menor tamaño en comparación con los que no obtuvieron respuesta tras la cirugía (11,85 mm vs. 12,96 mm; p = 0,009). El diámetro y el volumen del tercer ventrículo presentan una correlación fuerte significativa (coeficiente de Pearson = 0,72; p < 0,0001).

Conclusión

Los parámetros morfométricos del tercer ventrículo pueden resultar útiles para predecir una buena respuesta al shunt en los pacientes con HPNi.

Palabras clave:
Hidrocefalia a presión normal
Tercer ventrículo
Líquido cefalorraquídeo
Derivación ventriculoperitoneal

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