Early experience from the application of a noninvasive magnetic resonance imaging-based measurement of intracranial pressure in hydrocephalus

Roberta P. Glick, Josh Niebruegge, Sang H. Lee, Osbert Egibor, Terry Lichtor, Noam Alperin

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: The decision for surgical intervention in hydrocephalic patients presenting with symptoms suggesting raised intracranial pressure (ICP) is challenging because radiographic ventricular size often lacks the specificity to predict abnormal ICP. An early assessment of the potential clinical usefulness of a noninvasive magnetic resonance imaging-based measurement of ICP (MR-ICP) in symptomatic hydrocephalic patients is reported. METHODS: Twenty-seven symptomatic hydrocephalic patients (18 with shunts and 9 without shunts) underwent brain magnetic resonance imaging-based studies that included measurements of cerebrospinal fluid and blood flows to and from the cranial vault, from which measurements of ICP were derived using a previously described algorithm. The predictive values of the MR-ICP measurement were determined on the basis of whether or not the patient underwent a surgical treatment of a shunt placement or shunt revision within a 3-month period after the magnetic resonance imaging-based study. RESULTS: MR-ICP values in these patients spanned a much wider range than in healthy control subjects. However, the majority of the patients (20 out of 26 patients) had MR-ICP values within the normal range. The short-term follow-up of patients who had normal MR-ICP measurement reveals that only one of the 20 patients required surgery. Consequently, the MR-ICP measurement has a strong negative predictive value (95% for all patients and 100% for patients without a shunt). CONCLUSION: A finding of a normal MR-ICP value in hydrocephalic patients presenting with symptoms suggestive of abnormal ICP is a strong predictor for resolution of symptoms or stable outcome without surgical intervention.

Original languageEnglish
Pages (from-to)1052-1060
Number of pages9
JournalNeurosurgery
Volume59
Issue number5
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

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Intracranial Pressure
Hydrocephalus
Magnetic Resonance Imaging
Cerebrospinal Fluid
Healthy Volunteers
Reference Values

Keywords

  • Cerebrospinal fluid flow
  • Hydrocephalus
  • Magnetic resonance phase-contrast flow studies
  • Noninvasive intracranial pressure
  • Predictive values

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Early experience from the application of a noninvasive magnetic resonance imaging-based measurement of intracranial pressure in hydrocephalus. / Glick, Roberta P.; Niebruegge, Josh; Lee, Sang H.; Egibor, Osbert; Lichtor, Terry; Alperin, Noam.

In: Neurosurgery, Vol. 59, No. 5, 01.11.2006, p. 1052-1060.

Research output: Contribution to journalArticle

Glick, Roberta P. ; Niebruegge, Josh ; Lee, Sang H. ; Egibor, Osbert ; Lichtor, Terry ; Alperin, Noam. / Early experience from the application of a noninvasive magnetic resonance imaging-based measurement of intracranial pressure in hydrocephalus. In: Neurosurgery. 2006 ; Vol. 59, No. 5. pp. 1052-1060.
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AB - OBJECTIVE: The decision for surgical intervention in hydrocephalic patients presenting with symptoms suggesting raised intracranial pressure (ICP) is challenging because radiographic ventricular size often lacks the specificity to predict abnormal ICP. An early assessment of the potential clinical usefulness of a noninvasive magnetic resonance imaging-based measurement of ICP (MR-ICP) in symptomatic hydrocephalic patients is reported. METHODS: Twenty-seven symptomatic hydrocephalic patients (18 with shunts and 9 without shunts) underwent brain magnetic resonance imaging-based studies that included measurements of cerebrospinal fluid and blood flows to and from the cranial vault, from which measurements of ICP were derived using a previously described algorithm. The predictive values of the MR-ICP measurement were determined on the basis of whether or not the patient underwent a surgical treatment of a shunt placement or shunt revision within a 3-month period after the magnetic resonance imaging-based study. RESULTS: MR-ICP values in these patients spanned a much wider range than in healthy control subjects. However, the majority of the patients (20 out of 26 patients) had MR-ICP values within the normal range. The short-term follow-up of patients who had normal MR-ICP measurement reveals that only one of the 20 patients required surgery. Consequently, the MR-ICP measurement has a strong negative predictive value (95% for all patients and 100% for patients without a shunt). CONCLUSION: A finding of a normal MR-ICP value in hydrocephalic patients presenting with symptoms suggestive of abnormal ICP is a strong predictor for resolution of symptoms or stable outcome without surgical intervention.

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