gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The role of the craniospinal compliance with shunt indication

Die Rolle der kraniospinalen Compliance bei der Shuntindikation

Meeting Abstract

Suche in Medline nach

  • corresponding author M. Kiefer - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg-Saar
  • R. Eymann - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg-Saar
  • S. Chehab - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg-Saar
  • W. I. Steudel - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg-Saar

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.03.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc020.shtml

Veröffentlicht: 11. April 2007

© 2007 Kiefer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Recently MRI examinations pointed at a central role of the Compliance with the hydrocephalus genesis, while an elevation of the resistance to outflow (ROF) is seemingly only an epiphenomenon of a reduced compliance. The objective of this prospective study was to elaborate whether this new sight of the hydrocephalus pathophysiology may be proven with clinical data.

Methods: 180 patients with chronic hydrocephalus of various origins were examined. A dynamic infusion test, - a variant of a constant-flow infusion test which provides the ROF as well as the Pressure Volume Index (PVI) -, was performed in all patients, but was not used for shunt indication. The shunt indication was based on long-term ICP monitoring. 125 patients were shunted using gravitational valves. The follow-up was 4.6 1.8 years. Statistics: Spearman-, Kruskal-Wallis-, Wilcoxen-U-test.

Results: ROF alone had a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 40%, a sensitivity of 96% with a specificity of 7% at a critical value of 13 mmHg/ml x min. With a critical value of 18 mmHg/ml x min the NPV and sensitivity became worse, the increase of the PPV minimal and the specificity (26%) was clinically irrelevant. Similar to an isolated assessment of the PVI independent of different assumed critical value (22ml/30ml), the PPV and, - with a critical value of 30ml -, the sensitivity were in an acceptable clinical range, but specificity and NPV were unacceptable from a clinical viewpoint. Only a combined assessment and a logical “OR” combination of both values at a critical value of the PVI of 30ml and of the ROF of 13mmHg/ml x min provided clinically satisfying predictive values: sensitivity =97%, specificity =88%, PPV=80%, NPV=60%.

Conclusions: The results suggest that the recent neuroradiological idea of the hydrocephalus pathophysiology should be correct, because a combined assessment of both PVI and ROF provides the best prediction for successful shunting.