Evaluación de los marcadores radiológicos en hidrocefalia de presión normal y su relación con los resultados postoperatorios tras procedimientos de derivación

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dc.contributor.advisorGomez Amarillo, Diego Gomez
dc.contributor.advisorDe La Hoz, Jose
dc.contributor.authorRamirez Arquez, Ericka Julieth
dc.date.accessioned2025-02-13T13:40:31Z
dc.date.available2025-02-13T13:40:31Z
dc.date.issued2024-12
dc.description.abstractVarios signos radiológicos han sido reconocidos como valiosos complementos a los criterios clínicos en el diagnóstico de hidrocefalia normotensiva (HNP). Ciertos hallazgos de imágenes por resonancia magnética (IRM) también pueden brindar información sobre el pronóstico y los resultados posoperatorios de los pacientes sometidos a derivación ventricular. Sin embargo, la evidencia sigue sin ser concluyente y necesita más investigación. Realizamos un estudio de cohorte retrospectivo que incluyó pacientes del Centro de Atención Clínica de HNP de la Fundación Santa Fe de Bogotá. Evaluamos la asociación entre los hallazgos de la IRM preoperatoria y el estado clínico comparativo pre y posoperatorio de los pacientes. La mediana de edad fue de 80 años (RIC 75-85), y el 68,3% de los pacientes eran varones. Todos los pacientes presentaron trastornos de la marcha, con deterioro cognitivo (93,3%) y síntomas urinarios (83,3%) también prevalentes. Las características radiológicas revelaron una mediana de IE de 0,35 (RIC 0,33-0,37) y una mediana de CA de 85,2° (RIC 80-90). Se identificó DESH en el 60% de los pacientes y se observaron hiperintensidades periventriculares en el 48,3%. En el seguimiento de 1 mes, el 66,6% demostró una mejoría de la marcha, el 75,6% mostró una mejoría de los síntomas urinarios y el 83,0% mostró una mejoría cognitiva. Estas mejoras se mantuvieron a los 12 meses en el 63,8%, 63,8% y 69,0%, respectivamente. Se encontraron asociaciones estadísticamente significativas entre las hiperintensidades periventriculares y la mejoría de la marcha (p = 0,04) y entre DESH y la mejoría cognitiva a los 12 meses (p = 0,02). Sin embargo, parámetros como IE y CA, aunque consistentes con los umbrales de diagnóstico, no demostraron un valor pronóstico significativo en todos los resultados. Los parámetros de imagen desempeñan un papel matizado en la predicción de los resultados clínicos de la iNPH. Si bien los hallazgos como la DESH y las hiperintensidades periventriculares mostraron una utilidad pronóstica específica del dominio, el valor predictivo general de otros parámetros, incluidos la EI y la CA, fue limitado. La variabilidad en las correlaciones clínicas y de imagen destaca la necesidad de evaluaciones integradas y subraya la importancia de realizar más investigaciones con cohortes más grandes y multicéntricas para refinar las herramientas pronósticas y mejorar la selección de pacientes para los procedimientos de derivación.
dc.description.abstractenglishSeveral radiological signs have been recognized as valuable adjuncts to clinical criteria in normal pressure hydrocephalus (NPH) diagnosis. Certain magnetic resonance imaging (MRI) findings may also provide information on prognosis and postoperative outcomes of patients undergoing ventricular shunting. Nevertheless, the evidence remains inconclusive and needs further investigation. We conducted a retrospective cohort study that included patients from the Center for Clinical Care of NPH at Fundación Santa Fe de Bogotá. We assessed the association between pre-operative MRI findings and the patients' comparative pre- and postoperative clinical status. The median age was 80 years (IQR 75–85), with 68.3% of patients being male. All patients exhibited gait disturbances, with cognitive impairment (93.3%) and urinary symptoms (83.3%) also prevalent. Radiological characteristics revealed a median EI of 0.35 (IQR 0.33–0.37) and a median CA of 85.2° (IQR 80–90). DESH was identified in 60% of patients, and periventricular hyperintensities were present in 48.3%. At 1-month follow-up, 66.6% demonstrated gait improvement, 75.6% showed urinary symptom improvement, and 83.0% exhibited cognitive improvement. These improvements were sustained at 12 months in 63.8%, 63.8%, and 69.0%, respectively. Statistically significant associations were found between periventricular hyperintensities and gait improvement (p=0.04) and between DESH and cognitive improvement at 12 months (p=0.02). However, parameters such as EI and CA, while consistent with diagnostic thresholds, did not demonstrate significant prognostic value across all outcomes. Imaging parameters play a nuanced role in predicting clinical outcomes for iNPH. While findings such as DESH and periventricular hyperintensities showed domain-specific prognostic utility, the overall predictive value of other parameters, including EI and CA, was limited. Variability in imaging-clinical correlations highlights the need for integrated assessments and underscores the importance of further research with larger, multicenter cohorts to refine prognostic tools and improve patient selection for shunting procedures.
dc.description.degreelevelEspecializaciónspa
dc.description.degreenameEspecialista en Neurocirugíaspa
dc.description.sponsorshipFundacion Santa Fe de Bogota
dc.format.mimetypeapplication/pdf
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlrepourl:https://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/13941
dc.language.isoes
dc.publisher.facultyFacultad de Medicinaspa
dc.publisher.grantorUniversidad El Bosquespa
dc.publisher.programEspecialización en Neurocirugíaspa
dc.relation.references1. Moyet J, Baledent O, Slovenski T, Todessayi P, Metanbou S, Deschasse G, Bloch F, Capel C. Assessment of neurofluid dynamics in relation to clinical improvement after tap-test: pilot study. Acta Neurochir (Wien). 2024 Sep 3;166(1):358. doi: 10.1007/s00701-024-06239-z. PMID: 39225886.
dc.relation.references2. Damasceno BP. Neuroimaging in normal pressure hydrocephalus. Dement Neuropsychol. 2015 Oct-Dec;9(4):350-355. doi: 10.1590/1980-57642015DN94000350. PMID: 29213984; PMCID: PMC5619317.
dc.relation.references3. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965 Jul-Aug;2(4):307-27. doi: 10.1016/0022-510x(65)90016-x. PMID: 5889177.
dc.relation.references4. Yang Y, Yan M, Liu X, Li S, Lin G. Improve the diagnosis of idiopathic normal pressure hydrocephalus by combining abnormal cortical thickness and ventricular morphometry. Front Aging Neurosci. 2024 Feb 29;16:1338755. doi: 10.3389/fnagi.2024.1338755. PMID: 38486858; PMCID: PMC10937576.
dc.relation.references5. Yin R, Wen J, Wei J. Progression in Neuroimaging of Normal Pressure Hydrocephalus. Front Neurol. 2021 Nov 18;12:700269. doi: 10.3389/fneur.2021.700269. PMID: 34867705; PMCID: PMC8636440.
dc.relation.references6. Jaraj D, Wikkelsø C, Rabiei K, Marlow T, Jensen C, Östling S, Skoog I. Mortality and risk of dementia in normal-pressure hydrocephalus: A population study. Alzheimers Dement. 2017 Aug;13(8):850-857. doi: 10.1016/j.jalz.2017.01.013. Epub 2017 Feb 24. PMID: 28238737.
dc.relation.references7. Nakajima M, Yamada S, Miyajima M, et al.; research committee of idiopathic normal pressure hydrocephalus. Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo). 2021 Feb 15;61(2):63-97. doi: 10.2176/nmc.st.2020-0292. Epub 2021 Jan 15. PMID: 33455998; PMCID: PMC7905302.
dc.relation.references8. Pyrgelis ES, Velonakis G, Papageorgiou SG, Stefanis L, Kapaki E, Constantinides VC. Imaging Markers for Normal Pressure Hydrocephalus: An Overview. Biomedicines. 2023 Apr 24;11(5):1265. doi: 10.3390/biomedicines11051265. PMID: 37238936; PMCID: PMC10215615.
dc.relation.references9. McKhann G, Mayeux R. Brain drain: A bottom-up approach to normal pressure hydrocephalus. Ann Neurol. 2010 Oct;68(4):415–7.
dc.relation.references10. Toro J, Yepes M, Palacios E. Neurología. 2nd ed. Bogotá DC: Manual Moderno; 2014. 111–113 p.
dc.relation.references11. Vanneste JAL. Diagnosis and management of normal-pressure hydrocephalus. J Neurol. 2000 Jan 17;247(1):5–14.
dc.relation.references12. Avellino AM, Ransom B, Hu SC. Normal Pressure Hydrocephalus. Neuroscience Pearls.
dc.relation.references13. Gavrilov G V, Gaydar B V, Svistov D V, Korovin AE, Samarcev IN, Churilov LP, et al. IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS (HAKIM-ADAMS SYNDROME): CLINICAL SYMPTOMS, DIAGNOSIS AND TREATMENT. Medicina Academica Mostariensia. 2019 Nov 7;7(2):15–22.
dc.relation.references14. Decq P, Blanquet A, Yepes C. Percutaneous jugular placement of ventriculo-atrial shunts using a split sheath. Acta Neurochir (Wien) [Internet]. 1995;136(1):92–4. Available from: https://doi.org/10.1007/BF01411442
dc.relation.references15. Crowley RW, Dumont AS, Asthagiri AR, Torner JC, Medel R, Jane JAJ, et al. Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study. World Neurosurg. 2014 Feb;81(2):397–403.
dc.relation.references16. Shkolnik A, McLone DG. Intraoperative real-time ultrasonic guidance of ventricular shunt placement in infants. Radiology. 1981 Nov;141(2):515–7.
dc.relation.references17. Strowitzki M, Komenda Y, Eymann R, Steudel WI. Accuracy of ultrasound-guided puncture of the ventricular system. Child’s Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg. 2008 Jan;24(1):65–9.
dc.relation.references18. O’Leary ST, Kole MK, Hoover DA, Hysell SE, Thomas A, Shaffrey CI. Efficacy of the Ghajar Guide revisited: a prospective study. J Neurosurg. 2000 May;92(5):801–3.
dc.relation.references19. Virhammar J, Laurell K, Cesarini KG, Larsson EM. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 2014 Dec;35(12):2311-8. doi: 10.3174/ajnr.A4046. Epub 2014 Jul 10. PMID: 25012669; PMCID: PMC7965311.
dc.relation.references20. Agerskov S, Wallin M, Hellstrom P, Ziegelitz D, Wikkelso C, Tullberg M (2019) Absence of disproportionately enlarged subarachnoid space hydrocephalus, a sharp callosal angle, or other morphologic mri markers should not be used to exclude patients with idiopathic normal pressure hydrocephalus from shunt surgery. AJNR Am J Neuroradiol 40:74–79.
dc.relation.references21. Marmarou, A., Bergsneider, M., Relkin, N., Klinge, P., Black, P. M. (2005). Development of guidelines for idiopathic normal-pressure hydrocephalus. Neurosurgery, 57(3 Suppl), S1-3.
dc.relation.references22. Toma, A. K., Holl, E., Kitchen, N. D., Watkins, L. D. (2011). Evans' index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery, 68(4), 939-944; discussion 944.
dc.relation.references23. Virhammar J, Laurell K, Cesarini KG, Larsson E-M. The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus. J Neurosurg. 2014 Jan;120(1):178–84.
dc.relation.references24. Mantovani P, Albini-Riccioli L, Giannini G, Milletti D, Sorenson TJ, Stanzani-Maserati M, et al. Anterior Callosal Angle: A New Marker of Idiopathic Normal Pressure Hydrocephalus? World Neurosurg [Internet]. 2020;139(May):e548–52. Available from: https://doi.org/10.1016/j.wneu.2020.04.085
dc.relation.references25. Thavarajasingam SG, El-Khatib M, Vemulapalli K, Iradukunda HAS, K SV, Borchert R, Russo S, Eide PK. Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir (Wien). 2023 Feb;165(2):369-419. doi: 10.1007/s00701-022-05402-8. Epub 2022 Nov 26. PMID: 36435931; PMCID: PMC9922237.
dc.relation.references26. Hashimoto M, Ishikawa M, Mori E, Kuwana N. Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res. 2010 Oct;7:18.
dc.relation.references27. Craven CL, Toma AK, Mostafa T, Patel N, Watkins LD. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci Off J Neurosurg Soc Australas. 2016 Dec;34:294–8.
dc.relation.references28. Todisco M., Picascia M., Pisano P., Zangaglia R., Minafra B., Vitali P., Rognone E., Pichiecchio A., Ceravolo R., Vanacore N., et al. Lumboperitoneal shunt in idiopathic normal pressure hydrocephalus: A prospective controlled study. J. Neurol. 2020;267:2556–2566. doi: 10.1007/s00415-020-09844-x.
dc.relation.references29. Luikku A.J., Hall A., Nerg O., Koivisto A.M., Hiltunen M., Helisalmi S., Herukka S.K., Sutela A., Kojoukhova M., Mattila J., et al. Multimodal analysis to predict shunt surgery outcome of 284 patients with suspected idiopathic normal pressure hydrocephalus. Acta Neurochir. 2016;158:2311–2319. doi: 10.1007/s00701-016-2980-4.
dc.relation.references30. Reinard K, Basheer A, Phillips S, et al. Simple and reproducible linear measurements to determine ventricular enlargement in adults. Surg Neurol Int. 2015;6:59–59. doi: 10.4103/2152-7806.154777.
dc.relation.references31. Missori P., Rughetti A., Peschillo S., Gualdi G., Di Biasi C., Nofroni I., Marinelli L., Fattapposta F., Curra A. In normal aging ventricular system never attains pathological values of Evans’ index. Oncotarget. 2016;7:11860–11863. doi: 10.18632/oncotarget.7644.
dc.relation.references32. Ishii K, Kanda T, Harada A, Miyamoto N, Kawaguchi T, Shimada K, et al. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus. Eur Radiol. (2008) 18:2678–83. 10.1007/s00330-008-1044-4
dc.relation.references33. Relkin N., Marmarou A., Klinge P., Bergsneider M., Black P.M. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57:S4–S16. doi: 10.1227/01.NEU.0000168185.29659.C5.
dc.relation.references34. Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012;109:15–26. doi: 10.3238/arztebl.2012.0015.
dc.relation.references35. Kojoukhova M, Koivisto AM, Korhonen R, et al. Feasibility of radiological markers in idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2015;157:1709–1719. doi: 10.1007/s00701-015-2503-8.
dc.relation.references36. Bradley WG Jr. CSF flow in the brain in the context of normal pressure hydrocephalus. AJNR Am J Neuroradiol. (2015) 36:831–8. 10.3174/ajnr.A4124
dc.relation.references37. Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T (1998) CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. Am J Neuroradiol 19:1277–1284
dc.relation.references38. Holodny AI, George AE, De Leon MJ, et al. Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus. J Neurosurg. 1998;89:742–747. doi: 10.3171/jns.1998.89.5.0742.
dc.relation.references39. Kazui H, Miyajima M, Mori E, Ishikawa M. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol. (2015) 14:585–94. 10.1016/S1474-4422(15)00046-0
dc.relation.references40. Craven CL, Toma AK, Mostafa T, Patel N, Watkins LD. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci. (2016) 34:294–8. 10.1016/j.jocn.2016.09.004
dc.relation.references41. Hong Y.J., Kim M.J., Jeong E., Kim J.E., Hwang J., Lee J.I., Lee J.H., Na D.L. Preoperative biomarkers in patients with idiopathic normal pressure hydrocephalus showing a favorable shunt surgery outcome. J. Neurol. Sci. 2018;387:21–26. doi: 10.1016/j.jns.2018.01.017.
dc.relation.references42. Ishii K, Kawaguchi T, Shimada K, et al.: Voxel-based analysis of gray matter and CSF space in idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord 25: 329–335, 2008
dc.relation.references43. Yamashita F, Sasaki M, Takahashi S, et al. : Detection of changes in cerebrospinal fluid space in idiopathic normal pressure hydrocephalus using voxel-based morphometry. Neuroradiology 52: 381–386, 2010
dc.relation.references44. Lee WJ, Wang SJ, Hsu LC, Lirng JF, Wu CH, Fuh JL: Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus. J Neurol 257: 1675–1681, 2010
dc.relation.references45. Jack CR, Mokri B, Laws ER, et al. MR findings in normal-pressure hydrocephalus: significance and comparison with other forms of dementia. J Comput Assist Tomogr. 1987;6:923–931. doi: 10.1097/00004728-198711000-00001.
dc.relation.references46. Bradley WG, Whittemore AR, Watanabe AS, et al. Association of deep matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal-pressure hydrocephalus. Am J Neuroradiol. 1991;12:31–39.
dc.relation.references47. Krauss JK, Regel JP, Vach W, et al. Flow void of cerebrospinal fluid in idiopathic normal pressure hydrocephalus of the elderly: can it predict outcome after shunting? Neurosurgery. 1997;40:67–73. doi: 10.1097/00006123-199701000-00015.
dc.relation.references48. Algin O., Hakyemez B., Taskapilioglu O., Ocakoglu G., Bekar A., Parlak M. Morphologic features and flow void phenomenon in normal pressure hydrocephalus and other dementias: Are they really significant? Acad. Radiol. 2009;16:1373–1380. doi: 10.1016/j.acra.2009.06.010.
dc.relation.references49. Krauss J.K., Regel J.P., Vach W., Orszagh M., Jungling F.D., Bohus M., Droste D.W. White matter lesions in patients with idiopathic normal pressure hydrocephalus and in an age-matched control group: A comparative study. Neurosurgery. 1997;40:491–495. doi: 10.1097/00006123-199703000-00011.
dc.relation.references50. Bugalho P., Alves L. Normal-pressure hydrocephalus: White matter lesions correlate negatively with gait improvement after lumbar puncture. Clin. Neurol. Neurosurg. 2007;109:774–778. doi: 10.1016/j.clineuro.2007.07.012.
dc.relation.references51. Tullberg M, Jensen C, Ekholm S, Wikkelso C. Normal pressure hydrocephalus: vascular white matter changes on MRI must not exclude patients from shunt surgery. Am J Neuroradiol. 2001;22:1665–1673.
dc.relation.references52. Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012;109:15–26. doi: 10.3238/arztebl.2012.0015.
dc.relation.references53. Poca MA, Mataro M, Del Mar Matarin M, et al. Is the placement of shunts in patients with idiopathic normal-pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure. J Neurosurg 2004;100:855–66
dc.relation.references54. Børgesen SE, Gjerris F. The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 1982;105:65–86
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 Internationalen
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf2
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.localAcceso abiertospa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/4.0/
dc.subjectHidrocefalia de presión normal
dc.subjectHallazgos en imágenes
dc.subjectResonancia magnética
dc.subjectTríada de Hakim
dc.subject.keywordsNormal pressure hydrocephalus
dc.subject.keywordsImaging findings
dc.subject.keywordsMRI
dc.subject.keywordsHakim’s triad
dc.subject.nlmWL 368
dc.titleEvaluación de los marcadores radiológicos en hidrocefalia de presión normal y su relación con los resultados postoperatorios tras procedimientos de derivación
dc.title.translatedEvaluation of radiological markers in normal pressure hydrocephalus and its relationship with postoperative outcomes after shunt procedures
dc.type.coarhttps://purl.org/coar/resource_type/c_7a1f
dc.type.coarversionhttps://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.driverinfo:eu-repo/semantics/bachelorThesis
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.type.localTesis/Trabajo de grado - Monografía - Especializaciónspa

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