Korean J Neurotrauma.  2015 Apr;11(1):11-17. 10.13004/kjnt.2015.11.1.11.

Results of Isotope Cisternography in 175 Patients with a Suspected Hydrocephalus

• Lee KS
• Lee SM
• Shim JJ
• Yoon SM
• Bae HG
• Doh JW

• KMID: 2156086
• DOI: http://doi.org/10.13004/kjnt.2015.11.1.11

Abstract

OBJECTIVE
Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, memory impairment and urinary incontinence. The isotope cisternography (ICG) became less useful because of low accuracy and complications. We tried to evaluate the safety and value of the ICG.
METHODS
We retrospectively collected data on ICG of 175 consecutive patients with a suspected hydrocephalus. We classified the ICG into four types by the ventricular reflux and circulation time. The ventricular size was measured by Evans index and the width of the third ventricle.
RESULTS
There were three complications including one case of paraplegia. Type 4 was the most common type, observed in 53%. Type 3 (33%), type 2 (7%), and type 1 (7%) were observed less often. Type 4 was more common in patients with large ventricles. Types of the ICG were not related to the causes of hydrocephalus, gender, or age of the patients. Shunting was more frequently performed in type 4 (71%), compared to type 1 (17%), type 2 (33%), and type 3 (46%). Surgery was more common when the cause was vascular. After the shunt surgery, 33.0% were graded as the improved. Although there were some improvements even in the not-improved patients, they still needed many helps. The improvement was related to the preoperative state.
CONCLUSION
ICG may bring a serious complication, however the incidence is very low. Although the predictability of response rate on the shunting is doubtful, ICG is a cheap and useful tool to select surgical candidates in NPH.

Keyword

Hydrocephalus; Diagnosis; Radionuclide imaging; Meningitis, aseptic; Malpractice

MeSH Terms

Diagnosis
Gait
Humans
Hydrocephalus*
Hydrocephalus, Normal Pressure
Incidence
Malpractice
Memory
Meningitis, Aseptic
Paraplegia
Radionuclide Imaging
Retrospective Studies
Third Ventricle
Urinary Incontinence

Figure

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  FIGURE 1 Typical findings of isotope cisternography.

Reference

1. Algin O, Hakyemez B, Ocakoğlu G, Parlak M. MR cisternography:is it useful in the diagnosis of normal-pressure hydrocephalus and the selection of "good shunt responders"? Diagn Interv Radiol. 2011; 17:105–111. PMID: 20683818.

2. Algin O, Hakyemez B, Parlak M. The efficiency of PC-MRI in diagnosis of normal pressure hydrocephalus and prediction of shunt response. Acad Radiol. 2010; 17:181–187. PMID: 19910214.

3. Algin O, Turkbey B. Intrathecal gadolinium-enhanced MR cisternography: a comprehensive review. AJNR Am J Neuroradiol. 2013; 34:14–22. PMID: 22268089.

4. Ambrose T, Butler C, Myles L, Zeman A. Pitfalls in the diagnosis of hydrocephalus. Br J Hosp Med (Lond). 2008; 69:192–195. PMID: 18444337.

5. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg. 1997; 87:687–693. PMID: 9347976.

6. Bret P, Guyotat J, Chazal J. Is normal pressure hydrocephalus a valid concept in 2002? A reappraisal in five questions and proposal for a new designation of the syndrome as "chronic hydrocephalus". J Neurol Neurosurg Psychiatry. 2002; 73:9–12. PMID: 12082037.

7. Cooper JF, Harbert JC. Endotoxin as a cause of aseptic meningitis after radionuclide cisternography. J Nucl Med. 1975; 16:809–813. PMID: 1174137.

8. Eide PK, Brean A. Intracranial pulse pressure amplitude levels determined during preoperative assessment of subjects with possible idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien). 2006; 148:1151–1156. discussion 1156PMID: 17039303.

9. Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006; 2:375–381. PMID: 16932588.

10. Hebb AO, Cusimano MD. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery. 2001; 49:1166–1184. discussion 1184-1186PMID: 11846911.

11. Ivkovic M, Liu B, Ahmed F, Moore D, Huang C, Raj A, et al. Differential diagnosis of normal pressure hydrocephalus by MRI mean diffusivity histogram analysis. AJNR Am J Neuroradiol. 2013; 34:1168–1174. PMID: 23257611.

12. James AE Jr, New PF, Heinz ER, Hodges FJ, DeLand FH. A cisternographic classification of hydrocephalus. Am J Roentgenol Radium Ther Nucl Med. 1972; 115:39–49.

13. Jeon BS, Myung HJ, Kim SE, Chung JK, Koh CS. Patterns of radioisotope cisternographic findings (correlation between preoperative patterns and the results of surgical shunting in patients with communicating hydrocephalus). J Korean Neurol Assoc. 1987; 5:24–29.

14. Jonas S, Braunstein P. Neurogenic bladder as a complication of isotope cisternography. J Nucl Med. 1972; 13:763–764. PMID: 5056693.

15. Kawaguchi T, Hirata Y, Bundo M, Kondo T, Owaki H, Ito S, et al. Role of computerized tomographic cisternography in idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien). 2011; 153:2041–2048. discussion 2048PMID: 21611722.

16. Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012; 109:15–25. quiz 26PMID: 22282714.

17. Kim MK, Park BJ, Shin HS, Choi SK, Kim SB, Kim TS, et al. Clinical analysis of hydrocephalus patients who underwent shunt surgery after traumatic brain injury. J Korean Neurosurg Soc. 2011; 7:88–91.

18. Klinge P, Hellström P, Tans J, Wikkelsø C. European iNPH Multicentre Study Group. One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand. 2012; 126:145–153. PMID: 22571428.

19. Krauss JK, Halve B. Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice. Acta Neurochir (Wien). 2004; 146:379–388. discussion 388PMID: 15057532.

20. Levine MC, Jayabalan V. Complications of isotope cisternography. Ann Neurol. 1977; 1:172–176. PMID: 889301.

21. Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J. The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome. Arch Neurol. 1995; 52:783–789. PMID: 7639630.

22. Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005; 57(3 Suppl):S17–S28. discussion ii-vPMID: 16160426.

23. McGirr A, Mohammed S, Kurlan R, Cusimano MD. Clinical equipoise in idiopathic normal pressure hydrocephalus: a survey of physicians on the need for randomized controlled trials assessing the efficacy of cerebrospinal fluid diversion. J Neurol Sci. 2013; 333:13–18. PMID: 24012011.

24. Oi S. Classification of hydrocephalus: critical analysis of classification categories and advantages of "Multi-categorical Hydrocephalus Classification" (Mc HC). Childs Nerv Syst. 2011; 27:1523–1533. PMID: 21928018.

25. Park BS, Park J, Koh SH, Choi H, Yu HJ, Lee KE, et al. Conus medullaris syndrome as a complication of radioisotope cisternography. Can J Neurol Sci. 2012; 39:347–351. PMID: 22547516.

26. Park ES, Kim E. Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment. J Korean Neurosurg Soc. 2009; 45:1–4. PMID: 19242563.

27. Poca MA, Mataró M, Del Mar Matarín M, Arikan F, Junqué C, Sahuquillo J. 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; 100:855–866. PMID: 15137605.

28. Rekate HL. A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics. Childs Nerv Syst. 2011; 27:1535–1541. PMID: 21928019.

29. Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M. Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien). 2002; 144:515–523. discussion 523PMID: 12111484.

30. Sehgal AK, Sethi RS, Raghavan S, Namgyal PA. Radionuclide cisternography: A prudent investigation in diagnosing spontaneous intracranial hypotension. Indian J Nucl Med. 2013; 28:42–44. PMID: 24019678.

31. Verrees M, Selman WR. Management of normal pressure hydrocephalus. Am Fam Physician. 2004; 70:1071–1078. PMID: 15456116.

32. Walchenbach R, Geiger E, Thomeer RT, Vanneste JA. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2002; 72:503–506. PMID: 11909911.