open access

Vol 18, No 2 (2015)
Original articles
Published online: 2015-07-31
Submitted: 2015-07-31
Accepted: 2015-07-31
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Early brain perfusion improvement after ventriculoperitoneal shunt surgery in patients with idiopathic normal pressure hydrocephalus evaluated by 99mTc-HMPAO SPECT — preliminary report

Anna Nocuń, Anna Mosiewicz, Robert Kaczmarczyk, Teresa Kazalska, Elżbieta Czekajska-Chehab, Beata Chrapko, Tomasz Trojanowski
DOI: 10.5603/NMR.2015.0020
·
Pubmed: 26315868
·
Nucl. Med. Rev 2015;18(2):84-88.

open access

Vol 18, No 2 (2015)
Original articles
Published online: 2015-07-31
Submitted: 2015-07-31
Accepted: 2015-07-31

Abstract

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-existing abnormalities. The most popular treatment option is surgical implantation of a shunt. Brain perfusion increase occurring months or years after successful shunt surgery is well described in the literature. Early improvement of perfusion is not well documented. Therefore, the objective of the present study was to determine patterns of brain perfusion changes 3–6 days after the ventriculoperitoneal shunting in patients with iNPH by using 99mTc-HMPAO SPECT.

MATERIAL AND METHODS: Sixteen patients with iNPH (9 women, 7 men, mean age 64.1 ± 12.7 years) who underwent ventriculoperitoneal shunt surgery were included into the study group. Indications for implanting a shunt were based on clinical history, neuroimaging and CSF dynamic studies with an infusion test. Brain perfusion SPECT was performed 1–2 days before and 3–6 days after the surgical treatment. For comparison of perfusion before and after the surgery SPECT scans were assessed visually and semiquantitatively with voxel based analysis.

RESULTS: No side effects were observed after the surgery. Brain perfusion improvement after shunting was observed in 10 patients (62.5%). Patterns of perfusion changes varied between patients, with combinations of different bilateral and lateralized brain regions involved. Perfusion increased in the whole brain (3 patients), in the right cerebral hemisphere (1 patient) or in the separate cerebral regions (6 patients): frontal, parietal, temporal, cerebellum, cingulate gyrus. Perfusion improvement was predominantly observed in the frontal lobes: right frontal (3 cases, 18.8%), left frontal (3 cases, 18.8%).

CONCLUSIONS: Cerebral perfusion is recovered promptly after ventriculoperitoneal shunt surgery in about 60% of patients with iNPH. This improvement may be global or regional in different cerebral areas with prevalence of the frontal lobes.

Abstract

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-existing abnormalities. The most popular treatment option is surgical implantation of a shunt. Brain perfusion increase occurring months or years after successful shunt surgery is well described in the literature. Early improvement of perfusion is not well documented. Therefore, the objective of the present study was to determine patterns of brain perfusion changes 3–6 days after the ventriculoperitoneal shunting in patients with iNPH by using 99mTc-HMPAO SPECT.

MATERIAL AND METHODS: Sixteen patients with iNPH (9 women, 7 men, mean age 64.1 ± 12.7 years) who underwent ventriculoperitoneal shunt surgery were included into the study group. Indications for implanting a shunt were based on clinical history, neuroimaging and CSF dynamic studies with an infusion test. Brain perfusion SPECT was performed 1–2 days before and 3–6 days after the surgical treatment. For comparison of perfusion before and after the surgery SPECT scans were assessed visually and semiquantitatively with voxel based analysis.

RESULTS: No side effects were observed after the surgery. Brain perfusion improvement after shunting was observed in 10 patients (62.5%). Patterns of perfusion changes varied between patients, with combinations of different bilateral and lateralized brain regions involved. Perfusion increased in the whole brain (3 patients), in the right cerebral hemisphere (1 patient) or in the separate cerebral regions (6 patients): frontal, parietal, temporal, cerebellum, cingulate gyrus. Perfusion improvement was predominantly observed in the frontal lobes: right frontal (3 cases, 18.8%), left frontal (3 cases, 18.8%).

CONCLUSIONS: Cerebral perfusion is recovered promptly after ventriculoperitoneal shunt surgery in about 60% of patients with iNPH. This improvement may be global or regional in different cerebral areas with prevalence of the frontal lobes.

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Keywords

idiopathic normal pressure hydrocephalus, ventriculoperitoneal shunt, brain perfusion, 99mTc-HMPAO SPECT

About this article
Title

Early brain perfusion improvement after ventriculoperitoneal shunt surgery in patients with idiopathic normal pressure hydrocephalus evaluated by 99mTc-HMPAO SPECT — preliminary report

Journal

Nuclear Medicine Review

Issue

Vol 18, No 2 (2015)

Pages

84-88

Published online

2015-07-31

DOI

10.5603/NMR.2015.0020

Pubmed

26315868

Bibliographic record

Nucl. Med. Rev 2015;18(2):84-88.

Keywords

idiopathic normal pressure hydrocephalus
ventriculoperitoneal shunt
brain perfusion
99mTc-HMPAO SPECT

Authors

Anna Nocuń
Anna Mosiewicz
Robert Kaczmarczyk
Teresa Kazalska
Elżbieta Czekajska-Chehab
Beata Chrapko
Tomasz Trojanowski

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