Summary
Objectives
We investigated the effect of shunt surgery in patients with Normal Pressure Hydrocephalus (NPH) using Single Photon Emission Computerised Tomography (SPECT).
Materials & Methods
Thirteen patients diagnosed with NPH were assessed clinically and using (99mTc)-SPECT and MRI both pre- and post-operatively. Regions of interest were placed manually on T2 MRI and transferred to co-registered SPECT. Differences between pre- and post-operative cerebellum-normalised regional cerebral blood flow (rCBF) were calculated and analysed in relation to clinical findings represented by a new disability scale.
Results
The patients presented initially with 50 ± 30% disability score and improved following the surgery by 6 ± 10% (p = 0.1). We did not observe any significant rCBF changes in the whole group of patients (overall rCBF difference = +0.3%, p = 0.4). Some improvement was in basal frontal lateral cortex, basal ganglia and thalamus (+5%, p = 0.08 to 0.2). Patients with <30% disability score initially (N = 4) had a reversed pattern of changes compared to those with more symptoms (p < 0:05).
Conclusions
The small patient sample failed to show significant changes in rCBF due to NPH or surgery. There is indication that in patients with good initial clinical presentation there is little space for relevant clinical improvement and increase in rCBF.
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References
Arlig A, Larsson A, Bergh AC, Jacobsson L, Wikkelso C (1994) A new method for the relative quantification of rCBF examined by 99Tcm-HMPAO SPECT. Nucl Med Commun 15: 814–823
Larsson A, Stephensen H, Wikkelso C (1999) Adult patients with “asymptomatic” and “compensated” hydrocephalus benefit from surgery. Acta Neurol Scand 99: 81–90
Larsson A, Wikkelso C, Bilting M, Stephensen H (1991) Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 84: 475–482
Lindqvist G, Andersson H, Bilting M, Blomstrand C, Malmgren H, Wikkelso C (1993) Normal pressure hydrocephalus: psychiatric findings before and after shunt operation classified in a new diagnostic system for organic psychiatry. Acta Psychiatr Scand Suppl 373: 18–32
Owler BK, Pickard JD (2001) Normal pressure hydrocephalus and cerebral blood flow: a review. Acta Neurol Scand 104: 325–342
Soderstrom H, Hultin L, Tullberg M, Wikkelso C, Ekholm S, Forsman A (2002) Reduced frontotemporal perfusion in psychopathic personality. Psychiatry Res 114: 81–94
Tullberg M, Hellstrom P, Piechnik SK, Starmark J-E, Wikkelso C (2004) Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus. Acta Neurologica Scand (in press)
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© 2005 Springer-Verlag
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Piechnik, S.K., Hultin, L. (2005). Postoperative changes in SPECT-rCBF in hydrocephalus. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_36
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DOI: https://doi.org/10.1007/3-211-32318-X_36
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-24336-7
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