{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:18:24Z","timestamp":1790777904087,"version":"4.1.0"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,2]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>This study was performed in patients with idiopathic normal-pressure hydrocephalus (iNPH) to monitor cerebral metabolism with microdialysis (MD) and intracranial pressure (ICP) readings, and relate to the clinical responses to extended lumbar drainage (ELD) and shunt surgery.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The baseline levels of MD metabolites and ICP were monitored overnight in 40 consecutive patients with iNPH. In a subset of 28 patients, monitoring was continued during 3 days of ELD. Thirty-one patients received a ventriculoperitoneal shunt. The clinical severity of iNPH was determined before and then 3 and 6\u201312 months after shunt surgery.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Altered levels of MD markers (lactate, pyruvate, lactate\/pyruvate ratio, glutamate, and\/or glycerol) were seen in all patients at baseline; these improved during ELD. Despite normal static ICP (mean ICP), the pulsatile ICP (the ICP wave amplitude) was increased in 24 patients (60%). Only the level of the ICP wave amplitude differentiated the ELD and\/or shunt responders from nonresponders.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The MD monitoring indicated low-grade cerebral ischemia in patients with iNPH; during ELD, cerebral metabolism improved. The pulsatile ICP (the ICP wave amplitude) was the only variable differentiating the clinical responders from the nonresponders. The authors suggest that the pulsatile ICP reflects the intracranial compliance and that CSF diversion improves the biophysical milieu of the nerve cells, which subsequently may improve their biochemical milieu.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.5.jns09122","type":"journal-article","created":{"date-parts":[[2010,2,1]],"date-time":"2010-02-01T15:16:39Z","timestamp":1265037399000},"page":"414-424","source":"Crossref","is-referenced-by-count":39,"title":["Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery"],"prefix":"10.3171","volume":"112","author":[{"given":"Per K.","family":"Eide","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milo","family":"Stanisic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1120414","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1088","article-title":"Brain energy metabolism and intracranial pressure in idiopathic adult hydrocephalus syndrome","volume":"76","author":"Agren-Wilsson","year":"2005"},{"key":"b2-1120414","series-title":"J Neurol Neurosurg Psychiatry","first-page":"217","article-title":"Intracerebral microdialysis and CSF hydrodynamics in idiopathic adult hydrocephalus syndrome","volume":"74","author":"Agren-Wilsson","year":"2003"},{"key":"b3-1120414","series-title":"Intensive Care Med","first-page":"2166","article-title":"Consensus meeting on microdialysis in neurointensive care","volume":"30","author":"Bellander","year":"2004"},{"key":"b4-1120414","series-title":"J Neurol Neurosurg Psychiatry","first-page":"847","article-title":"Risk factors for the syndrome of ventricular enlargement with gait apraxia (idiopathic normal pressure hydrocephalus): a case-control study","volume":"52","author":"Casmiro","year":"1989"},{"key":"b5-1120414","series-title":"Neuroscience","first-page":"346","article-title":"Chronic hydrocephalus-induced hypoxia: increased expression of VEGFR-2+ and blood vessel density in hippocampus","volume":"152","author":"Dombrowski","year":"2008"},{"key":"b6-1120414","series-title":"Brain Pathol","first-page":"325","article-title":"Chronic hydrocephalus in adults","volume":"14","author":"Edwards","year":"2004"},{"key":"b7-1120414","series-title":"Acta Neurochir (Wien)","first-page":"21","article-title":"Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients treated with ventriculoperitoneal shunts","volume":"148","author":"Eide","year":"2006"},{"key":"b8-1120414","series-title":"Med Eng Phys","first-page":"579","article-title":"A new method for processing of continuous intracranial pressure signals","volume":"28","author":"Eide","year":"2006"},{"key":"b9-1120414","series-title":"Acta Anaesthesiol Scand","first-page":"1273","article-title":"Association between intracranial pulse pressure levels and brain energy metabolism in a patient with an aneurysmal subarachnoid haemorrhage","volume":"51","author":"Eide","year":"2007"},{"key":"b10-1120414","series-title":"Acta Neurochir (Wien)","first-page":"1151","article-title":"Intracranial pulse pressure amplitude levels determined during preoperative assessment of subjects with possible idiopathic normal pressure hydrocephalus","volume":"148","author":"Eide","year":"2006"},{"key":"b11-1120414","series-title":"Neurol Res","first-page":"798","article-title":"Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds","volume":"29","author":"Eide","year":"2007"},{"key":"b12-1120414","series-title":"J Neurosurg","first-page":"573","article-title":"Effects of ventriculoperitoneal shunt removal on cerebral oxygenation and brain compliance in chronic obstructive hydrocephalus","volume":"94","author":"Fukuhara","year":"2001"},{"key":"b13-1120414","series-title":"Acta Neurochir (Wien)","first-page":"166","article-title":"Pulse amplitude and volume-pressure relationships in experimental hydrocephalus","volume":"97","author":"Gonz\u00e1les-Darder","year":"1989"},{"key":"b14-1120414","series-title":"Neurology","first-page":"868","article-title":"Idiopathic normal pressure hydrocephalus and systemic hypertension","volume":"37","author":"Graff-Radford","year":"1987"},{"key":"b15-1120414","series-title":"J Neurol Sci","first-page":"307","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. 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