{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T20:21:43Z","timestamp":1782505303886,"version":"3.54.5"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,7]]},"abstract":"\nObject<\/jats:title>\nThe ability to predict outcome after shunt placement in patients with idiopathic normal-pressure hydrocephalus (NPH) represents a challenge. To date, no single diagnostic tool or combination of tools has proved capable of reliably predicting whether the condition of a patient with suspected NPH will improve after a shunting procedure. In this paper, the authors report their experience with 120 patients with the goal of identifying CSF hydrodynamics criteria capable of selecting patients with idiopathic NPH. Specifically, they focused on the comparison between CSF-outflow resistance (R-out) and intracranial elastance (IE).<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nBetween January 1977 and December 2005, 120 patients in whom idiopathic NPH had been diagnosed (on the basis of clinical findings and imaging) underwent CSF hydrodynamics evaluation based on an intraventricular infusion test. Ninety-six patients underwent CSF shunt placement: 32 between 1977 and 1989 (Group I) on the basis of purely clinical and radiological criteria; 44 between 1990 and 2002 (Group II) on the basis of the same criteria as Group I and because they had an IE slope > 0.25; and 20 between 2003 and 2005 (Group III) on the basis of the same criteria as Group II but with an IE slope \u2265 0.30. Outcomes were evaluated by means of both Stein-Langfitt and Larsson scores. Patients' conditions were considered improved when there was a stable decrease (at 6- and 12-month follow-up) of at least 1 point in the Stein-Langfitt score and 2 points in the Larsson score.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nGroup I: while no statistically significant difference in mean R-out value between improved and unimproved cases was observed, a clear-cut IE slope value of 0.25 differentiated very sharply between unimproved and improved cases. Group II: R-out values in the 2 unimproved cases were 20 and 47 mm Hg\/ml\/min, respectively. The mean IE slope in the improved cases was 0.56 (range 0.30\u20131.4), while the IE slopes in the 2 unimproved cases were 0.26 and 0.27. Group III: the mean IE slope was 0.51 (range 0.31\u20130.7). The conditions of all patients improved after shunting. A significant reduction of the Evans ratio was observed in 34 (40.5%) of the 84 improved cases and in none of the unimproved cases.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nOur strategy based on the analysis of CSF pulse pressure parameters seems to have a great accuracy in predicting surgical outcome in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.1.jns091296","type":"journal-article","created":{"date-parts":[[2010,2,12]],"date-time":"2010-02-12T13:37:24Z","timestamp":1265981844000},"page":"64-73","source":"Crossref","is-referenced-by-count":60,"title":["Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience"],"prefix":"10.3171","volume":"113","author":[{"given":"Carmelo","family":"Anile","sequence":"first","affiliation":[{"name":"Institute of Neurosurgery, Catholic University School of Medicine, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Institute of Neurosurgery, Catholic University School of Medicine, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Albanese","sequence":"additional","affiliation":[{"name":"Institute of Neurosurgery, Catholic University School of Medicine, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Di Chirico","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Ospedale Santo Spirito, Rome; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annunziato","family":"Mangiola","sequence":"additional","affiliation":[{"name":"Institute of Neurosurgery, Catholic University School of Medicine, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Petrella","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Azienda Ospedaliera S. Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Santini","sequence":"additional","affiliation":[{"name":"Institute of Neurosurgery, Catholic University School of Medicine, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns091296","series-title":"Acta Neurol Scand","first-page":"333","article-title":"CSF biomarkers in the evaluation of idiopathic normal pressure hydrocephalus","volume":"116","author":"Agren-Wilsson","year":"2007"},{"key":"b2-jns091296","series-title":"Childs Nerv Syst","first-page":"325","article-title":"Cerebral blood flow autoregulation during intracranial hypertension: a simple, purely hydraulic mechanism?","volume":"25","author":"Anile","year":"2009"},{"key":"b3-jns091296","series-title":"Neurosurgery","first-page":"389","article-title":"Intracranial compliance is time-dependent","volume":"20","author":"Anile","year":"1987"},{"key":"b4-jns091296","series-title":"Acta Neurochir (Wien)","first-page":"455","article-title":"Can MR measurement of intracranial hydrodynamics and compliance differentiate which patient with idiopathic normal pressure hydrocephalus will improve following shunt insertion?","volume":"149","author":"Bateman","year":"2007"},{"key":"b5-jns091296","series-title":"Acta Neurochir (Wien)","first-page":"1","article-title":"Surgical indications in normotensive hydrocephalus. 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Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"Hakim","year":"1965"},{"key":"b17-jns091296","series-title":"J Neurol Neurosurg Psychiatry","first-page":"479","article-title":"Is a combination of Tc-SPECT or perfusion weighted magnetic resonance imaging with spinal tap test helpful in the diagnosis of normal pressure hydrocephalus?","volume":"74","author":"Hertel","year":"2003"},{"key":"b18-jns091296","series-title":"Neurosurgery","first-page":"124","article-title":"Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?","volume":"60","author":"Kahlon","year":"2007"},{"key":"b19-jns091296","series-title":"Acta Neurol Scand","first-page":"379","article-title":"Lumbar infusion test in normal pressure hydrocephalus","volume":"111","author":"Kahlon","year":"2005"},{"key":"b20-jns091296","series-title":"Acta Neurochir Suppl","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1007\/3-211-30714-1_75","article-title":"Outcome predictors for normal-pressure hydrocephalus","volume":"96","author":"Kiefer","year":"2006"},{"key":"b21-jns091296","series-title":"Acta Neurol Scand","first-page":"475","article-title":"Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus","volume":"84","author":"Larsson","year":"1991"},{"key":"b22-jns091296","series-title":"J Neurosurg","first-page":"944","article-title":"Cerebrospinal fluid pulse pressure method: a possible substitute for the examination of B waves","volume":"101","author":"Lenfeldt","year":"2004"},{"issue":"3 Suppl","key":"b23-jns091296","series-title":"Neurosurgery","first-page":"S17","article-title":"The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus","volume":"57","author":"Marmarou","year":"2005"},{"issue":"3 Suppl","key":"b24-jns091296","series-title":"Neurosurgery","first-page":"S1","article-title":"Development of guidelines for idiopathic normal-pressure hydrocephalus: introduction","volume":"57","author":"Marmarou","year":"2005"},{"key":"b25-jns091296","series-title":"J Neurosurg","first-page":"987","article-title":"Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients","volume":"102","author":"Marmarou","year":"2005"},{"key":"b26-jns091296","series-title":"Acta Neurochir Suppl","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/3-211-32318-X_62","article-title":"Non-invasive measurement of intracranial compliance using cine MRI in normal pressure hydrocephalus","volume":"95","author":"Mase","year":"2005"},{"key":"b27-jns091296","series-title":"J Neurosurg","first-page":"1036","article-title":"Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus","volume":"100","author":"Meier","year":"2004"},{"key":"b28-jns091296","series-title":"Neuroradiology","first-page":"377","article-title":"Is there a correlation between operative results and change in ventricular volume after shunt placement? A study of 60 cases of idiopathic normal-pressure hydrocephalus","volume":"45","author":"Meier","year":"2003"},{"key":"b29-jns091296","series-title":"J Magn Reson Imaging","first-page":"274","article-title":"Noninvasive MRI assessment of intracranial compliance in idiopathic normal pressure hydrocephalus","volume":"26","author":"Miyati","year":"2007"},{"key":"b30-jns091296","series-title":"Acta Neurochir (Wien)","first-page":"255","article-title":"Quantitative local cerebral blood flow change after cerebrospinal fluid removal in patients with normal pressure hydrocephalus measured by a double injection method with N-isopropyl-p-[(123)I] iodoamphetamine","volume":"144","author":"Mori","year":"2002"},{"key":"b31-jns091296","series-title":"Acta Neurol Scand","first-page":"317","article-title":"In vivo assessment of hydrocephalus shunt","volume":"120","author":"Petrella","year":"2009"},{"issue":"3 Suppl","key":"b32-jns091296","series-title":"Neurosurgery","first-page":"S4","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005"},{"key":"b33-jns091296","series-title":"Acta Neurochir (Wien)","first-page":"69","article-title":"Normotensive hydrocephalus. 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Predicting the results of cerebrospinal fluid shunting","volume":"41","author":"Stein","year":"1974"},{"key":"b37-jns091296","series-title":"J Neurosurg","first-page":"19","article-title":"A fast method of estimating the elastance of the intracranial system","volume":"47","author":"Szewczykowski","year":"1977"},{"key":"b38-jns091296","series-title":"J Neurotrauma","first-page":"836","article-title":"The role of computerized rheoencephalography in the assessment of normal pressure hydrocephalus","volume":"22","author":"Traczewski","year":"2005"},{"key":"b39-jns091296","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1021","article-title":"Three decades of normal pressure hydrocephalus: are we wiser now?","volume":"57","author":"Vanneste","year":"1994"},{"key":"b40-jns091296","series-title":"J Neurol Neurosurg Psychiatry","first-page":"503","article-title":"The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus","volume":"72","author":"Walchenbach","year":"2002"},{"key":"b41-jns091296","series-title":"J Neurol","first-page":"1465","article-title":"Alteration of cerebral perfusion in patients with idiopathic normal pressure hydrocephalus measured by 3D perfusion weighted magnetic resonance imaging","volume":"252","author":"Walter","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/1\/article-p64.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/1\/article-p64.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/1\/article-p64.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:29:07Z","timestamp":1679891347000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/1\/article-p64.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,7]]},"references-count":41,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2010.1.jns091296","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,7]]}}}