Information capacity of cerebral hemodynamic system signs in estimating of liquor flow system at patients with hydrocephalus

Background. It was shown an opportunity of non-invasive diagnostics of intracranial hypertension (ICH) on the base of pulsatility index (PI) using transcranial Doppler (TCD) in most neurosurgical patients. But in patients with hydrocephalus PI is controversial. This may be due to different degree of cerebral autoregulation (CA) impairment in case of cerebral perfusion pressure decrease. Purpose: to assess the informativity of cerebral hemodynamics indices for assessment of cerebrospinal fluid circulation in patients with hydrocephalus. Materials and methods. Routine diagnostics of cerebral blood flow velocity (BFV) by means of TCD was carried out in 26 patients with hydrocephalus. Cerebral autoregulation was assessed perioperatively with cuff test and cross-spectral analysis of spontaneous oscillations of blood pressure and BVF within the range of Meyer waves. Results. Depending on presence of intracranial hypertension (ICH), all patients have been divided in two groups: with signs of ICH (1^st group) and without ICH (2^nd group). Mean values of PI didn’t differ significantly in both groups. At the same time rate of CA were considerably (p<0.01) higher in patients without signs of ICH. In the 1^st group postoperative clinical improvement was accompanied with considerable (p<0.05) increase of rate of CA. In the 2^nd group of operated patients we didn’t observe any positive changes in neurological state postoperatively. After surgery CA hasn’t been changed significantly. Conclusion. Assessment of cerebral autoregulation being more informative than PI evaluation can increase TCD valuability in noninvasive diagnostics of cerebrospinal liquid dynamics and could be used for clarifying indications for operation in patients with hydrocephalus.

гидроцефалия, внутричерепная гипертензия, ликворообращение, ауторегуляция мозгового кровотока, hydrocephalus, intracranial hypertension, cerebrospinal fluid circulation, cerebral autoregulation

1. Aaslid R., Lindegaard K., Sorteberg W., Nornes H. Cerebral autoregulation dynamics in humans // Stroke. - 1989 - Vol. 20. - P. 45-52.

2. Bakker S.L., Boon A.J., Wijnhoud A.D., Dippel D.W., Delwel E.J., Koudstaal P.J. Cerebral hemodynamics before and after shunting in normal pressure hydrocephalus // Acta Neurologica Scandinavica 2002 - Volume 106. - P. 123-127.

3. Behrens A., Lenfeldt N., Ambarki K., Malm J., Eklund A., Koskinen L.O. Transcranial Doppler pulsatility index: not an accurate method to assess intracranial pressure // Neurosurgery. - 2010. -Vol. 66(6). - P. 1050-7.

4. Boon A., Tans J.T., Delwel E.J., Egeler-Peerdeman S.M., Hanio P.W., Wurzer P.W., Hermans J. How to select patients for shunting? An analysis of four diagnostic criteria // Surg Neurol. - 2000. - Vol. 53. - P. 201-7.

5. Boon A.J., Tans J.T., Delwel E.J., Egeler-Peerdeman S.M., Hanio P.W., Wurzer H.A., Avezaat C.J., De Jong D.A., Gooskens R.H., Hermans J. Dutch normal pressure hydrocephalus study. Prediction of outcome after shunting with the resistance to outflow of cerebrospinal fluid // J Neurosurg. - 1997. - Vol. 87. - P. 687-93.

6. Chang C.C., Asada H., Mimura T., Suzuki S. A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus // J Neurosurg. - 2009. - Vol. 111. - P. 610-617.

7. Chang C.C., Kuwana N., Ito S., Ikegami T. Prediction of effectiveness of shunting in patients with normal pressure hydrocephalus by cerebral blood flow measurement and computed tomography // Neurol Med Chir (Tokyo). - 1999 - Vol. 39. - P. 841-846.

8. Czosnyka Z., Czosnyka M., Lavinio A., Keong N., Pickard J. D. Clinical testing of CSF circulation // European Journal of Anaesthesiology - 2008. - Vol. 25 (Suppl 42). - P. 142-145.

9. Czosnyka Z., Czosnyka M., Owler B., Momjan S., Kasparovicz M., Schmidt E.A., Smielevsky P., Pickard J.D. The relationship between CSF circulation and cerebrovascular pressure reactivity in normal pressure hydrocephalus // Acta Neurochirurgica (Supplement). - 2005. - Vol. 95. - P. 207-212.

10. Czosnyka Z., Czosnyka M., Whitfield P.C., Donovan T., Pickard J.D. Cerebral Autoregulation among Patients with Symptoms of Hydrocephalus // Neurosurgery - 2002. - Vol. 50 (3) - P. 526-533.

11. Diehl R., Linden D., Lucke D., Berlit P. Phase relationship between cerebral blood flow velocity and blood pressure. A clinical test of autoregulation // Stroke. - 1995. - Vol. 26. - P. 1801-1804.

12. Dombrowski S., Crutchfield K., Ligon K., Becker J., Luciano M. Evidence for CSF-vascular compliance coupling in normal pressure hydrocephalus // Cerebrospinal Fluid Research - 2009. - Vol. 6 (Suppl 1). - P. 36.

13. Dubois B., Slachevsky A., Litvan I., Pillon B. The FAB: a Frontal Assessment Battery at bedside // Neurology. - 2000. - Vol. 55(11). - P. 1621-6.

14. Evans W.A. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy // Arch Neurol Psychiatry. - 1942. - Vol. 47(6). - P. 931-937.

15. Georgia A. Pulsatility Index May Predict Poor Outcome After Intracerebral Hemorrhage // Covering Neurology - 2003. - Vol. 61. - P. 1051-6.

16. Graff-Radford N.R., Rezai K., Godersky J.C., Eslinger P., Damasio H., Kirchner P.T. Regional cerebral blood flow in normal pressure hydrocephalus // J Neurol Neurosurg Psychiatry - 1987. - Vol. 50. - P. 1589-1596.

17. Greitz T.V., Grepe A.O., Kalmer M.S., Lopez J. Pre - and post-operative evaluation of CBF in low-pressure hydrocephalus // J Neurosurg - 1969. - Vol. 31. - P. 644-651.

18. Gur A.Y., Kesler A., Shopin L., Bornstein N.M. Transcranial Doppler for evaluation of idiopathic intracranial hypertension // Acta Neurol Scand. - 2007. - Vol. 116. - P. 239-242.

19. Haan J., Thomeer R.T. Predictive value of temporary external lumbar drainage in normal pressure hydrocephalus // Neurosurgery. - 1988. - Vol. 22. - P. 388-391.

20. Hanlo P. W., Gooskens R., Nijhuis I., Faber J., Peters R., Huffelen A, Tulleken C.A., Willemse J. Value of transcranial Doppler indices in predicting raised ICP in infantile hydrocephalus // Child’s Nervous System. - 1995. - Vol. 11. - P. 595-603.

21. Hartman A., Alberti E. Cerebral blood flow and cerebral blood volume in communicating hydrocephalus // Arch Psychiatr Nervenkr. - 1978. - Vol. 225. - P. 291-306.

22. Hassler W., Steinmetz H., Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest // J Neurosurg. - 1988. - Vol. 68. - P. 745-51.

23. Hill A., Volpe J.J. Decrease in pulsatile flow in the anterior cerebral arteries in infantile hydrocephalus // Pediatrics. - 1982. - Vol. 69(1). - P. 4-7.

24. Jindal A., Mahapatra A.K. Correlation of ventricular size and transcranial Doppler findings before and after ventricular peritoneal shunt in patients with hydrocephalus: prospective study of 35 patients. J Neurol Neurosurg Psychiatry. 1998 - Vol. 65 - P. 269-271.

25. Kahlon B., Sundbarg G., Rehncrona S. Lumbar infusion test in normal pressure hydrocephalus // Acta Neurol Scand - 2005. - Vol. 111. - P. 379-384.

26. Katzman R., Hussey F. A simple constant infusion manometric test for measurement of CSF absorption // Neurology. - 1970. - Vol. 20. - P. 534-544.

27. Kushner M., Younkin D., Weinberger J., Hurtig H., Goldberg H., Reivich M. Cerebral hemodynamics in the diagnosis of normal pressure hydrocephalus // Neurology. - 1984. - Vol. 34. - P. 96-99.

28. Larsson A., Bergh A.C., Bilting M., Arlig A., Jacobsson L., Stephansen H., Wikkelso C. Regional cerebral blood flow in normal pressure hydrocephalus: Diagnostic and prognostic aspects // Eur J Nucl Med - 1994. - Vol. 21. - P. 118-123.

29. Lavinio A., Schmidt E., Haubrich C., Smielewski P., Pickard J., Czosnyka M. Noninvasive evaluation of dynamic cerebrovascular autoregulation using Finapres plethysmograph and transcranial Doppler // Stroke. - 2007. - Vol. 38(2). - P. 402-404.

30. Lee H., Hu C., Whang K., Kim H.-J. Transcranial Doppler and Cerebrospinal Fluid Flow Study in Normal Pressure Hydrocephalus // J Korean Neurosurg Soc. 2006 - Vol. 39. - P. 20-26.

31. Malm J., Kristensen B., Karlsson T. The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome // Arch Neurol. - 1995. -Vol. 52. - P. 783-9.

32. Mamo H.L., Meric P.C., Ponsin J.C., Rey A.C., Luft A.G., Seylaz J.A. Cerebral blood flow in normal pressure hydrocephalus // Stroke. - 1987. - Vol. 18(6). - P. 1074-80.

33. Marmarou A., Shulman K., Rosende R. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg // 1978. - Vol. 48. - P. 332-344.

34. Marth-Fabregas J., Belvrn R., Guardia E., Cocho D., Mucoz J., Marruecos L., Marth-Vilalta J.-L. Prognostic value of Pulsatility Index in acute intracerebral hemorrhage // Neurology. - 2003. - Vol. 61 (8) - P. 1051-1056.

35. Mathew N.T., Meyer J.S., Hartmann A., Ott E.O. Abnormal CSF fluid-blood flow dynamics // Arch Neurol. - 1975. - Vol. 32. - P. 657-664.

36. Matsuda M., Nakasu S., Nakazawa T., Handa J. Cerebral hemodynamics in patients with normal pressure hydrocephalus: correlation between cerebral circulation time and dementia // Surg Neuro1 - 1990. - Vol. 34. - P. 396-401.

37. Momjian S., Owler B.K., Czosnyka Z., Czosnyka M., Pena A., Pickard J.D. Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus // Brain. - 2004. - Vol. 127. - P. 965-72.

38. Nadvi S.S., Du Trevou M.D., Vandellen J.R. The use of TCD ultrasonography as a method of assessing ICP in hydrocephalic children. Br J Neurosurg. - 1994. - Vol. 8. - P. 573-577.

39. Owler B.K., Pickard J.D. Cerebral Blood Flow and Normal Pressure Hydrocephalus. A Review // Acta Neurologica Scandinavica - 2001. - Vol. 104. - P. 325-342.

40. Quinn M.W., Pople I.K. Middle cerebral artery pulsatility in children with blocked cerebrospinal fluid shunts // J Neurol Neurosurg Psychiatry. - 1992. - Vol. 55. - P. 325-327.

41. Raichle M.E., Eichling J.O., Gado M., Grubb R.L. Cerebral blood flow volume in dementia // Neurology. - 1974. - Vol. 24. - P. 350-54.

42. Relkin N., Marmarou A., Klinge P., Bergsneider M., Black P. INPH Guidelines Study Group. Guidelines for the Diagnosis and Management of Idiopathic Normal-Pressure Hydrocephalus // Neurosurgery. - 2005 - Vol. 57(3). - S2.

43. Schmidt J.F., Andersen A.R., Paulson O.B., Gjerris F. Angiotensin converting enzyme inhibition: CBF autoregulation and ICP in patients with normal-pressure hydrocephalus // Acta Neurochir (Wien). - 1990. - Vol. 106. - P. 9-12.

44. Synek V., Reuben J.R., Du Boulay G.H. Comparing Evans’ index and computerized axial tomography in assessing relationship of ventricular size to brain size // Neurology. - 1976. - Vol. 26(3). - P. 231-233.

45. Tanaka A., Kimura M., Nakayama Y., Yoshinaga S., Tomonaga M. Cerebral blood flow and autoregulation in normal pressure hydrocephalus // Neurosurgery. - 1997. - Vol. 40. - 1161-5.

46. Vorstrup S., Christensen J., Gjerris F., Sorensen P.S., Thomsen A.M., Paulson O.B. Cerebral blood flow in patients with nor-mal-pressure hydrocephalus before and after CSF shunting // J. Neurosurg. - 1987. - Vol. 66. - P. 379-387.

47. Walchenbach R., Geiger E., Thomeer R.T., Vanneste J. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus // J Neurol Neurosurg Psychiatry. - 2002. - Vol. 72. - P. 503-506.

48. Waldemar G., Schmidt J.F., Delecluse F., Andersen A.R., Gjerris F., Paulson O.B. High resolution SPECT with [99mTc]-d,l-HMPAO in normal pressure hydrocephalus before and after shunt operation // J Neurol Neurosurg Psychiatry. - 1993. - Vol. 56. - P. 655-664.

49. Weerakkody R.A., Czosnyka M., Schumann M.U., Schmidt E., Keong N., Santarius T., Pickard J.D., Czosnyka Z. Clinical assessment of cerebrospinal fluid dynamics in hydrocephalus. Guide to interpretation based on observational study // Acta Neurol Scand - 2011. - Vol. 124(2). - P. 85-98.