Ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus increases midbrain size

A potential mechanism for gait improvement

J. Mocco, Matthew I. Tomey, Ricardo J Komotar, William J. MacK, Steven J. Frucht, Robert R. Goodman, Guy M. McKhann

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm; postoperative mean, 6.90 ± 0.25 cm; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

Original languageEnglish
Pages (from-to)847-850
Number of pages4
JournalNeurosurgery
Volume59
Issue number4
DOIs
StatePublished - Oct 1 2006
Externally publishedYes

Fingerprint

Normal Pressure Hydrocephalus
Mesencephalon
Gait
Ventriculoperitoneal Shunt
Urinary Incontinence
Dementia

Keywords

  • Gait
  • Midbrain
  • Normal pressure hydrocephalus
  • Shunt
  • Ventriculoperitoneal

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus increases midbrain size : A potential mechanism for gait improvement. / Mocco, J.; Tomey, Matthew I.; Komotar, Ricardo J; MacK, William J.; Frucht, Steven J.; Goodman, Robert R.; McKhann, Guy M.

In: Neurosurgery, Vol. 59, No. 4, 01.10.2006, p. 847-850.

Research output: Contribution to journalArticle

Mocco, J. ; Tomey, Matthew I. ; Komotar, Ricardo J ; MacK, William J. ; Frucht, Steven J. ; Goodman, Robert R. ; McKhann, Guy M. / Ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus increases midbrain size : A potential mechanism for gait improvement. In: Neurosurgery. 2006 ; Vol. 59, No. 4. pp. 847-850.
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AU - MacK, William J.

AU - Frucht, Steven J.

AU - Goodman, Robert R.

AU - McKhann, Guy M.

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AB - OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm; postoperative mean, 6.90 ± 0.25 cm; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

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