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Brain Imaging

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Imaging normal pressure hydrocephalus: theories, techniques, and challenges.

Nicole C H Keong^1,2, Alonso Pena³, Stephen J Price²

¹Department of Neurosurgery, National Neuroscience Institute and Duke-NUS Medical School, Singapore;

Neurosurgical Focus

|September 2, 2016

Summary

The pathophysiology of Normal Pressure Hydrocephalus (NPH) is debated, with unclear roles for imaging in predicting cerebrospinal fluid (CSF) shunting success. This paper reviews imaging studies and theories on NPH development.

Keywords:

CBF = cerebral blood flow DESH = disproportionately enlarged subarachnoid-space hydrocephalus DTI DTI = diffusion tensor imaging ICP = intracranial pressure NPH NPH = normal pressure hydrocephalus PET = positron emission tomography REM = rapid eye movement ROI = region of interest Rcsf = resistance to CSF outflow SINPHONI = Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement SPECT = single photon emission computed tomography VP = ventriculoperitoneal [11C]PiB = carbon 11 labeled Pittsburgh Compound B iNPH = idiopathic NPH imaging rCBV = regional cerebral blood volume theories

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Area of Science:

Neurology
Radiology
Neurosurgery

Background:

Normal Pressure Hydrocephalus (NPH) pathophysiology remains debated, impacting clinical management.
Established guidelines exist, but consensus on imaging's role in NPH characterization and shunt success prediction is lacking.
Clinical presentation variability and imperfect shunt response hinder novel imaging technique application.

Purpose of the Study:

To review major theories on Normal Pressure Hydrocephalus (NPH) evolution.
To discuss the relevance of key imaging studies in understanding NPH pathophysiology.
To address the lack of consensus regarding imaging modalities in NPH.

Main Methods:

Literature review of major theoretical frameworks for NPH pathogenesis.
Analysis of seminal and recent imaging studies relevant to NPH.
Discussion integrating imaging findings with NPH theories.

Main Results:

Identified key imaging modalities and their contributions to understanding NPH.
Highlighted the challenges posed by clinical variability and shunt response in NPH research.
Synthesized different perspectives on NPH pathophysiology.

Conclusions:

Further research is needed to reconcile imaging findings with NPH pathogenesis theories.
Standardizing imaging interpretation could improve NPH diagnosis and treatment prediction.
A deeper understanding of NPH pathophysiology is crucial for advancing diagnostic and therapeutic strategies.