Abstract
Objective The strict relationship between shunt-responsiveness and increased resistance to CSF outflow (Rout) as reported in 1981 by Borgensen and Gjerris [1] was later presented as significant but not strong in the‘Dutch NPH’ trial [2] and recently reported as unconvincing in the ‘European NPH study’ [3]. We reviewed our ongoing database to study the relationship between parameters describing CSF circulation and pressure-volume compensation with clinical improvement after shunting.
Highlights
Compensatory parameters were calculated on the basis of infusion test: baseline ICP and pulse amplitude, resistance to CSF outflow (Rout), elasticity, estimator of CSF production, slope of amplitude-pressure regression line
Consultants deciding about shunting were not blind to results of infusion study
Of all calculated CSF compensatory parameters, only Rout was associated with outcome (p=0.014)
Summary
The strict relationship between shunt-responsiveness and increased resistance to CSF outflow (Rout) as reported in 1981 by Borgensen and Gjerris [1] was later presented as significant but not strong in the‘Dutch NPH’ trial [2] and recently reported as unconvincing in the ‘European NPH study’ [3]. We reviewed our ongoing database to study the relationship between parameters describing CSF circulation and pressure-volume compensation with clinical improvement after shunting. All patients had probable NPH following clinical assessment including imaging. Patients underwent lumbar or intraventricular infusion studies and were available for follow-up via the multidisciplinary CSF clinic. Compensatory parameters were calculated on the basis of infusion test: baseline ICP and pulse amplitude, Rout, elasticity, estimator of CSF production, slope of amplitude-pressure regression line. Consultants deciding about shunting were not blind to results of infusion study
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