Index of cerebrospinal compensatory reserve in hydrocephalus

Dong Ju Kim, Zofia Czosnyka, Nicole Keong, Danila K. Radolovich, Peter Smielewski, Michael P F Sutcliffe, John D. Pickard, Marek Czosnyka

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

OBJECTIVE: An index of cerebrospinal compensatory reserve (RAP) has been introduced as a potential descriptor of neurological deterioration after head trauma. It is numerically computed as a linear correlation coefficient between the mean intracranial pressure and the pulse amplitude of the pressure waveform. We explore how RAP varies with different forms of physiological or nonphysiological intracranial volume loads in adult hydrocephalus, with and without a functioning cerebrospinal fluid (CSF) shunt. METHODS: A database of intracranial pressure recordings during CSF infusion studies and overnight monitoring in hydrocephalic patients was reviewed for clinical comparison of homogeneous subgroups of patients with hypothetical differences of pressure-volume compensatory reserve. The database includes 980 patients of mixed etiology: idiopathic normal pressure hydrocephalus (NPH), 47%; postsubarachnoid hemorrhage NPH, 12%; noncommunicating hydrocephalus, 22%; others, 19%. All CSF compensatory parameters were calculated by using intracranial pressure waveforms. RESULTS: In NPH, RAP correlated strongly with the resistance to CSF outflow (rs = 0.35; P= 0.045), but weakly correlated with ventriculomegaly (rs = 0.13; P= 0.41). In idiopathic nonshunted NPH patients, RAP did not correlate significantly with elasticity calculated from the CSF infusion test (rs = 0.11; P= 0.21). During infusion studies, RAP increased in comparison to values recorded at baseline (from a median of 0.45-0.86, P = 0.14*10-8), indicating a narrowing of the volume-pressure compensatory reserve. During B-waves associated with the REM (rapid eye movement) phase of sleep, RAP increased from a median of 0.53 to 0.89; P = 1.2*10-5. After shunting, RAP decreased (median before shunting, 0.59; median after shunting, 0.34; P = 0.0001). RAP also showed the ability to reflect the functional state of the shunt (patent shunt median, 0.36; blocked shunt median, 0.84; P = 0.0002). CONCLUSION: RAP appears to characterize pressure-volume compensatory reserve in patients with hydrocephalus.

Original languageEnglish
Pages (from-to)494-501
Number of pages8
JournalNeurosurgery
Volume64
Issue number3
DOIs
Publication statusPublished - 2009 Mar 1
Externally publishedYes

Fingerprint

Normal Pressure Hydrocephalus
Hydrocephalus
Cerebrospinal Fluid
Intracranial Pressure
Pressure
Cerebrospinal Fluid Shunts
Databases
Aptitude
REM Sleep
Elasticity
Craniocerebral Trauma
Sleep
Hemorrhage
Blood Pressure

Keywords

  • Hydrocephalus
  • Pressure-volume compensation
  • Shunting
  • Waveform analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Kim, D. J., Czosnyka, Z., Keong, N., Radolovich, D. K., Smielewski, P., Sutcliffe, M. P. F., ... Czosnyka, M. (2009). Index of cerebrospinal compensatory reserve in hydrocephalus. Neurosurgery, 64(3), 494-501. https://doi.org/10.1227/01.NEU.0000338434.59141.89

Index of cerebrospinal compensatory reserve in hydrocephalus. / Kim, Dong Ju; Czosnyka, Zofia; Keong, Nicole; Radolovich, Danila K.; Smielewski, Peter; Sutcliffe, Michael P F; Pickard, John D.; Czosnyka, Marek.

In: Neurosurgery, Vol. 64, No. 3, 01.03.2009, p. 494-501.

Research output: Contribution to journalArticle

Kim, DJ, Czosnyka, Z, Keong, N, Radolovich, DK, Smielewski, P, Sutcliffe, MPF, Pickard, JD & Czosnyka, M 2009, 'Index of cerebrospinal compensatory reserve in hydrocephalus', Neurosurgery, vol. 64, no. 3, pp. 494-501. https://doi.org/10.1227/01.NEU.0000338434.59141.89
Kim DJ, Czosnyka Z, Keong N, Radolovich DK, Smielewski P, Sutcliffe MPF et al. Index of cerebrospinal compensatory reserve in hydrocephalus. Neurosurgery. 2009 Mar 1;64(3):494-501. https://doi.org/10.1227/01.NEU.0000338434.59141.89
Kim, Dong Ju ; Czosnyka, Zofia ; Keong, Nicole ; Radolovich, Danila K. ; Smielewski, Peter ; Sutcliffe, Michael P F ; Pickard, John D. ; Czosnyka, Marek. / Index of cerebrospinal compensatory reserve in hydrocephalus. In: Neurosurgery. 2009 ; Vol. 64, No. 3. pp. 494-501.
@article{e17635178cbc419398c7e44df72bef46,
title = "Index of cerebrospinal compensatory reserve in hydrocephalus",
abstract = "OBJECTIVE: An index of cerebrospinal compensatory reserve (RAP) has been introduced as a potential descriptor of neurological deterioration after head trauma. It is numerically computed as a linear correlation coefficient between the mean intracranial pressure and the pulse amplitude of the pressure waveform. We explore how RAP varies with different forms of physiological or nonphysiological intracranial volume loads in adult hydrocephalus, with and without a functioning cerebrospinal fluid (CSF) shunt. METHODS: A database of intracranial pressure recordings during CSF infusion studies and overnight monitoring in hydrocephalic patients was reviewed for clinical comparison of homogeneous subgroups of patients with hypothetical differences of pressure-volume compensatory reserve. The database includes 980 patients of mixed etiology: idiopathic normal pressure hydrocephalus (NPH), 47{\%}; postsubarachnoid hemorrhage NPH, 12{\%}; noncommunicating hydrocephalus, 22{\%}; others, 19{\%}. All CSF compensatory parameters were calculated by using intracranial pressure waveforms. RESULTS: In NPH, RAP correlated strongly with the resistance to CSF outflow (rs = 0.35; P= 0.045), but weakly correlated with ventriculomegaly (rs = 0.13; P= 0.41). In idiopathic nonshunted NPH patients, RAP did not correlate significantly with elasticity calculated from the CSF infusion test (rs = 0.11; P= 0.21). During infusion studies, RAP increased in comparison to values recorded at baseline (from a median of 0.45-0.86, P = 0.14*10-8), indicating a narrowing of the volume-pressure compensatory reserve. During B-waves associated with the REM (rapid eye movement) phase of sleep, RAP increased from a median of 0.53 to 0.89; P = 1.2*10-5. After shunting, RAP decreased (median before shunting, 0.59; median after shunting, 0.34; P = 0.0001). RAP also showed the ability to reflect the functional state of the shunt (patent shunt median, 0.36; blocked shunt median, 0.84; P = 0.0002). CONCLUSION: RAP appears to characterize pressure-volume compensatory reserve in patients with hydrocephalus.",
keywords = "Hydrocephalus, Pressure-volume compensation, Shunting, Waveform analysis",
author = "Kim, {Dong Ju} and Zofia Czosnyka and Nicole Keong and Radolovich, {Danila K.} and Peter Smielewski and Sutcliffe, {Michael P F} and Pickard, {John D.} and Marek Czosnyka",
year = "2009",
month = "3",
day = "1",
doi = "10.1227/01.NEU.0000338434.59141.89",
language = "English",
volume = "64",
pages = "494--501",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Index of cerebrospinal compensatory reserve in hydrocephalus

AU - Kim, Dong Ju

AU - Czosnyka, Zofia

AU - Keong, Nicole

AU - Radolovich, Danila K.

AU - Smielewski, Peter

AU - Sutcliffe, Michael P F

AU - Pickard, John D.

AU - Czosnyka, Marek

PY - 2009/3/1

Y1 - 2009/3/1

N2 - OBJECTIVE: An index of cerebrospinal compensatory reserve (RAP) has been introduced as a potential descriptor of neurological deterioration after head trauma. It is numerically computed as a linear correlation coefficient between the mean intracranial pressure and the pulse amplitude of the pressure waveform. We explore how RAP varies with different forms of physiological or nonphysiological intracranial volume loads in adult hydrocephalus, with and without a functioning cerebrospinal fluid (CSF) shunt. METHODS: A database of intracranial pressure recordings during CSF infusion studies and overnight monitoring in hydrocephalic patients was reviewed for clinical comparison of homogeneous subgroups of patients with hypothetical differences of pressure-volume compensatory reserve. The database includes 980 patients of mixed etiology: idiopathic normal pressure hydrocephalus (NPH), 47%; postsubarachnoid hemorrhage NPH, 12%; noncommunicating hydrocephalus, 22%; others, 19%. All CSF compensatory parameters were calculated by using intracranial pressure waveforms. RESULTS: In NPH, RAP correlated strongly with the resistance to CSF outflow (rs = 0.35; P= 0.045), but weakly correlated with ventriculomegaly (rs = 0.13; P= 0.41). In idiopathic nonshunted NPH patients, RAP did not correlate significantly with elasticity calculated from the CSF infusion test (rs = 0.11; P= 0.21). During infusion studies, RAP increased in comparison to values recorded at baseline (from a median of 0.45-0.86, P = 0.14*10-8), indicating a narrowing of the volume-pressure compensatory reserve. During B-waves associated with the REM (rapid eye movement) phase of sleep, RAP increased from a median of 0.53 to 0.89; P = 1.2*10-5. After shunting, RAP decreased (median before shunting, 0.59; median after shunting, 0.34; P = 0.0001). RAP also showed the ability to reflect the functional state of the shunt (patent shunt median, 0.36; blocked shunt median, 0.84; P = 0.0002). CONCLUSION: RAP appears to characterize pressure-volume compensatory reserve in patients with hydrocephalus.

AB - OBJECTIVE: An index of cerebrospinal compensatory reserve (RAP) has been introduced as a potential descriptor of neurological deterioration after head trauma. It is numerically computed as a linear correlation coefficient between the mean intracranial pressure and the pulse amplitude of the pressure waveform. We explore how RAP varies with different forms of physiological or nonphysiological intracranial volume loads in adult hydrocephalus, with and without a functioning cerebrospinal fluid (CSF) shunt. METHODS: A database of intracranial pressure recordings during CSF infusion studies and overnight monitoring in hydrocephalic patients was reviewed for clinical comparison of homogeneous subgroups of patients with hypothetical differences of pressure-volume compensatory reserve. The database includes 980 patients of mixed etiology: idiopathic normal pressure hydrocephalus (NPH), 47%; postsubarachnoid hemorrhage NPH, 12%; noncommunicating hydrocephalus, 22%; others, 19%. All CSF compensatory parameters were calculated by using intracranial pressure waveforms. RESULTS: In NPH, RAP correlated strongly with the resistance to CSF outflow (rs = 0.35; P= 0.045), but weakly correlated with ventriculomegaly (rs = 0.13; P= 0.41). In idiopathic nonshunted NPH patients, RAP did not correlate significantly with elasticity calculated from the CSF infusion test (rs = 0.11; P= 0.21). During infusion studies, RAP increased in comparison to values recorded at baseline (from a median of 0.45-0.86, P = 0.14*10-8), indicating a narrowing of the volume-pressure compensatory reserve. During B-waves associated with the REM (rapid eye movement) phase of sleep, RAP increased from a median of 0.53 to 0.89; P = 1.2*10-5. After shunting, RAP decreased (median before shunting, 0.59; median after shunting, 0.34; P = 0.0001). RAP also showed the ability to reflect the functional state of the shunt (patent shunt median, 0.36; blocked shunt median, 0.84; P = 0.0002). CONCLUSION: RAP appears to characterize pressure-volume compensatory reserve in patients with hydrocephalus.

KW - Hydrocephalus

KW - Pressure-volume compensation

KW - Shunting

KW - Waveform analysis

UR - http://www.scopus.com/inward/record.url?scp=62849104010&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62849104010&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000338434.59141.89

DO - 10.1227/01.NEU.0000338434.59141.89

M3 - Article

C2 - 19240611

AN - SCOPUS:62849104010

VL - 64

SP - 494

EP - 501

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -