Normal Basınçlı Hidrosefalinin Beyin Mrg Bulguları ile Değerlendirilmesi
Özet
The aim of this study is to reveal the profile of imaging findings in patients with
idiopathic Normal Pressure Hydrocephalus (iNBH), to determine the correlation
between these imaging findings and clinical findings, and to investigate the
possibility of predicting the response to surgery based on imaging findings before
ventriculo-peritoneal shunt surgery. Between December 2020 and December 2022,
patients who presented with one or more of the following complaints: gait
disturbance, cognitive impairment, or urinary incontinence and had ventriculomegaly
on cranial Magnetic Resonance Imaging (MRI) and met the 2021 iNBH diagnostic
criteria were included in the study. Neuroimaging findings were analyzed both
qualitatively and quantitatively with volumetric calculations using volBrain software.
The clinical course of the patients after VP shunt surgery was followed
prospectively. The study included 75 patients (44% female, 56% male; mean age
71.23 years). Pre-treatment qualitative and quantitative MRI findings were correlated
with the classic clinical triad of dementia, gait disturbance and urinary incontinence.
Disproportionate widening of the sylvian sulcus or other sulci (DESH) was found in
73 patients (98%) and narrowing of the callosal angle in 71 patients (95%).
Widening of the calcarine sulcus was found in 20% of patients and parietooccipital
sulcus in 32%. Compressed mesencephalon was observed in 26 patients (35%). The
incidence of dementia was significantly higher in patients with normal CSF flow rate
(p=0.033). No significant correlation was found between pre-treatment gait
disturbance and urinary incontinence and any imaging findings (p>0.05). In our
study, we also used the Decision Tree method to determine how the variables affect
the clinical findings together. Separate models were created for each complaint.
According to the decision tree evaluating the effect of variables on gait disturbance:
Gait-balance impairment was seen in patients with DESH findings. Gait impairment
was seen in patients without DESH but with sulcal narrowing from the level of the
vertex and compressed mesencephalon. Diagnostic draining lumbar puncture (LP)
was performed in 64 and external lumbar drainage (ELD) in 9 of the 75 patients
included in the study. Patients without periventricular T2 hyperintensities had a
significantly higher positive response to LP. A total of 42 patients underwent VP
shunt surgery. When the change in dementia after treatment was analyzed in relation
to MRI findings, it was found that improvement in dementia was significantly lower
only in the presence of interhemispheric DESH (p=0.011). When the relationship
between the change in gait disturbance and MRI findings after treatment was
analyzed, improvement in gait disturbance was found in all patients with sulcal
narrowing at the level of the vertex (p=0.004). In addition, the mean volume of the
fourth ventricle was 1.55 cm3 in patients who did not respond to surgical
intervention and 3.28 cm3 in patients who responded (p=0.024). There was no
significant correlation between improvement in urinary incontinence after treatment
and any MRI findings (p>0.05).
The findings showed that enlargement of the parietooccipital and calcarine sulci and
compressed mesencephalon findings are not uncommon in patients with iNBH,
response to LP was increased in patients without periventricular white matter lesions,
and response to VP shunt was increased in patients with mesial sulcal narrowing.