{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T00:35:09Z","timestamp":1699662909364},"reference-count":26,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder presenting a triad including dementia and ventricular enlargement. The mechanism causing excessive cerebrospinal fluid (CSF) accumulation in the ventricles in iNPH is poorly understood. We hypothesized that the age-related degradation of the spinal shock-absorbing system composed of a spinal dural sac (SDS) and surrounding soft tissue, preventing ventricular enlargement caused by wide CSF pulsation driven by heartbeats, may be involved in the ventricular enlargement observed in iNPH.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>Sixty-four patients with iNPH in their seventies who underwent a lumboperitoneal shunt and a control group of 79 people in the same age group who underwent brain check-ups were included in the study. We compared the sizes of the cervical and upper parts of the thoracic SDS using magnetic resonance imaging between the two groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>The anterior-posterior distances of the dural sac at C5 were shorter in patients with iNPH of both sexes than those in the control group (<jats:italic>P<\/jats:italic> = 0.0008 in men and <jats:italic>P<\/jats:italic> = 0.0047 in women). The number of disc levels with disappeared CSF space surrounding the cervical cord was more in iNPH (<jats:italic>P<\/jats:italic> = 0.0176 and <jats:italic>P<\/jats:italic> = 0.0003). The midsagittal area of the upper part of the spinal sac, C2-Th4, was smaller in iNPH (<jats:italic>P<\/jats:italic> = 0.0057 and <jats:italic>P<\/jats:italic> = 0.0290).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Narrowing of the cervical dural sac and midsagittal area in the upper part of the SDS in patients with iNPH may reflect the degradation of the shock-absorbing mechanism for CSF pressure pulsations, which may cause iNPH or at least aggravate iNPH by other unknown causes.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_474_2023","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T08:13:04Z","timestamp":1699603984000},"page":"391","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patients of idiopathic normal-pressure hydrocephalus have small dural sac in cervical and upper thoracic levels: A supposed causal association"],"prefix":"10.25259","volume":"14","author":[{"given":"Takashi","family":"Kawahara","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Arita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Fujio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nayuta","family":"Higa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Science, Kagoshima University, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"FM","family":"Moinuddin","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, United States."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryosuke","family":"Hanaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"10.25259\/SNI_474_2023\/ref-1","first-page":"e0217705","article-title":"Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study","volume-title":"PLoS One","volume":"14","author":"Andersson","year":"2019"},{"key":"10.25259\/SNI_474_2023\/ref-2","first-page":"1","article-title":"Studies on the cerebro-spinal fluid: I. 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