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Reversibility of brain morphology after shunt operations and preoperative clinical symptoms in patients with idiopathic normal pressure hydrocephalus
Author(s) -
Wada Tamiki,
Kazui Hiroaki,
Yamamoto Daisuke,
Nomura Keiko,
Sugiyama Hiromichi,
Shimizu Yoshiro,
Yoshida Tetsuhiko,
Yoshiyama Kenji,
Yamashita Fumio,
Kishima Haruhiko,
Yoshimine Toshiki,
Takeda Masatoshi
Publication year - 2013
Publication title -
psychogeriatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.647
H-Index - 32
eISSN - 1479-8301
pISSN - 1346-3500
DOI - 10.1111/psyg.12001
Subject(s) - medicine , shunt (medical) , hydrocephalus , magnetic resonance imaging , cerebrospinal fluid , brain morphometry , lateral ventricles , ventricular system , brain size , white matter , cardiology , radiology , anesthesia , pathology
Aim Brain deformations might prevent clinical symptoms from worsening in patients with idiopathic normal pressure hydrocephalus ( iNPH ). We investigated the relationship between reversibility of brain morphology after shunt operations and preoperative clinical symptoms in iNPH patients. Methods Using head magnetic resonance images with voxel‐based morphometry, we measured the cerebrospinal fluid volume in the combined areas of the lateral and third ventricles and Sylvian fissure (the volume of the ventricles and S ylvian fissure ( vVS )) and the volume of the subarachnoid space at high convexity and midline areas ( vHCM ) before and 1 year after lumboperitoneal shunt operations in 12 patients with shunt‐responsive iNPH . We used the ratio of normalized vVS to normalized vHCM ( nvVS/nvHCM ) as an index of the severity of the brain deformation. The degree of reversibility of the brain morphology after the shunt operation was defined as the change ratio of the preoperative nvVS/nvHCM to the postoperative nvVS/nvHCM ( CR‐nvVS/nvHCM ). Higher CR‐nvVS/nvHCM values indicated more improvement in the brain deformation. In addition, we rated the severity of the white matter lesions on the preoperative magnetic resonance images based on the F azekas scale. Dependency in activities of daily living, gait and cognition were evaluated before and 1 year after the shunt operations. Results After the shunt operations, the nvVS/nvHCM and nvVS decreased significantly, and nvHCM increased significantly. The CR‐nvVS/nvHCM negatively correlated with the preoperative severity of dependency in activities of daily living, gait and cognitive impairments. The CR‐nvVS/nvHCM negatively correlated with the F azekas scale, but not with age, duration of the disease and cerebrospinal fluid pressure. Conclusions Reversibility of brain morphology, which varied among iNPH patients, would prevent clinical symptoms from worsening in iNPH patients. The presence of white matter lesions reduced the degree of reversibility of the brain deformations in iNPH patients.