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Comparison Between Ventricular and Spinal Infusion Tests in Suspected Normal Pressure Hydrocephalus
Francesco Signorelli1,2, Gianluca Trevisi3,4, Massimiliano Visocchi2
1Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Acta Neurochirurgica. Supplement
|December 28, 2023
Summary
Idiopathic normal pressure hydrocephalus (iNPH) diagnosis can be improved with infusion tests. Intraventricular infusion tests (IVKT) are more invasive but potentially more reliable than Spinal Katzman Tests (SKT) for iNPH diagnosis.
Area of Science:
- Neurology
- Neurosurgery
- Medical Diagnostics
Background:
- Idiopathic normal pressure hydrocephalus (iNPH) is a treatable dementia caused by ventriculomegaly.
- Symptoms include gait disturbance, cognitive decline, and urinary incontinence.
- Surgical shunting offers a potential treatment for iNPH.
Purpose of the Study:
- To compare the diagnostic utility of the Spinal Katzman Test (SKT) and intraventricular infusion test (IVKT) for iNPH.
- To evaluate the reliability of Intracranial Elastance Index (IEI) and outflow resistance (Rout) in iNPH diagnosis.
Main Methods:
- Retrospective analysis of 106 patients with suspected normotensive hydrocephalus undergoing infusion tests (2001-2017).
- Calculated Intracranial Elastance Index (IEI) and outflow resistance (Rout) for all patients.
- Compared results from 52 patients undergoing SKT with 54 patients undergoing IVKT.
Main Results:
- Pathological elastance was found in 71% of SKT patients and 92% of IVKT patients.
- Higher rates of pathological elastance and abnormal Rout (>12 mmHg) were observed in the IVKT group.
- IVKT demonstrated higher sensitivity in identifying abnormal intracranial elastance and resistance.
Conclusions:
- Both IVKT and SKT are valuable tools for diagnosing iNPH.
- IVKT, despite being more invasive, appears more reliable for iNPH diagnosis, especially in complex cases.
- IEI and Rout measurements are crucial components of these diagnostic tests.
