Hydrocephalus and ICP Monitoring
From head micro-motions towards CSF dynamics and non-invasive intracranial pressure monitoring
We developed a unique differential geometry-based method of non-invasive intracranial pressure monitoring that yields a broader and global perspective on intracranial cerebrospinal fluid dynamics compared to rather local catheter-based measurement and has the potential for wider applications.
Comparison of decline in different cognitive domain in patients with normal pressure hydrocephalus
We sought to describe the cognitive profile of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) using a comprehensive neuropsychological battery. Based on age and education correlated norms, we aimed to compare performance in each measured cognitive domain: executive functions (EFs), verbal memory (VM), non-verbal memory (nVM), visuoconstructional abilities (VA) and attention/psychomotor speed (A/PS). Patients diagnosed with iNPH underwent comprehensive neuropsychological evaluation before shunting. Their performance was compared to the age and education correlated norms. Correlation of different cognitive domains in iNPH profile was performed.
Diffusion tensor imaging helps identify shunt-responsive normal pressure hydrocephalus patients among probable iNPH cohort
The aim of this study was to investigate whether white matter changes as measured by diffusion tensor imaging (DTI) can help differentiate shunt-responsive idiopathic normal pressure hydrocephalus (iNPH) patients from patients with other causes of gait disturbances and/or cognitive decline with ventriculomegaly whose clinical symptoms do not improve significantly after cerebrospinal fluid derivation (non-iNPH).
Prediction of shunt responsiveness in suspected patients with normal pressure hydrocephalus using the lumbar infusion test: a machine learning approach
We successfully used the machine learning approach to predict the outcome of a 5-day external lumbar drainage and hence to predict which patients are likely to benefit from permanent shunt implantation. Our automated machine learning model thus enhances the diagnostic utility of lumbar infusion test in normal pressure hydrocephalus management.
Boosting phase-contrast MRI performance in idiopathic normal pressure hydrocephalus diagnostics by means of machine learning approach
Feature extraction algorithms combined with machine learning approaches simplify the utilization of phase-contrast MRI. Phase-contrast MRI boosted by the machine learning approach can help to determine shunt-responsive idiopathic normal pressure hydrocephalus patients.
First experiences with Miethke M.blue® valve in iNPH patients
The initial results with M.blue® shunt system in iNPH patients are promising. Positive clinical effect was found in 21 shunted iNPH patients at three months. The highest response was found in gait. Incontinence was mitigated and despite stable MoCA results, specific tests showed that learning and executive abilities slightly improved. Implantation had low complication rates and no mortality. More studies are needed to provide rationale for gravitational valves in iNPH. We recommend increasing the initial valve setting by 2-4 cm H2O above manufacturer’s recommendation, especially in lean patients.
Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients
The groups of probable idiopathic normal pressure hydrocephalus patients with gait impairment diagnosed by high DESH score or positive functional testing did not overlap and DESH score did not correlate with gait improvement after external lumbar drainage. We stated that DESH score should not be used as a simple diagnostic or prognostic marker of idiopathic normal pressure hydrocephalus, and we could not confirm the benefit of measurement of callosal angle and cingulate sulcus sign.
Structural volumetry in NPH diagnostics and treatment – future or dead end?
This study was performed with a goal to assess automated volumetric analysis as a potential presurgical diagnostic tool or as a method to potentially shed light on normal pressure hydrocephalus (NPH) pathophysiology. Even though a detailed volumetric study shows several significant differences, we found that volumetric analysis as a standalone method does not provide a simple diagnostic biomarker, nor does it shed a light on an unknown normal pressure hydrocephalus etiology.
Normal pressure hydrocephalus—an overview of pathophysiological mechanisms and diagnostic procedures
Despite the development of diagnostic techniques and strategies in management, NPH remains to be a challenge for the specialists despite more than 50 years of research. However, results of this research have brought new opportunities in the diagnosis, therapy, and quality of life as well as survival time of NPH patients with improved symptoms. The aim of this article is to present the pathophysiological hypotheses of NPH and an overview of the diagnostic techniques used for the evaluation of NPH patients.
Cerebrovascular Topics
Overview of cerebral cavernous malformations: comparison of treatment approaches
As a globally most robust meta-analysis to the topic, we investigated various aspects of all treatment approaches toward cavernoma treatment while simultaneously studying prognostic factors of bleeding. Finding various risk factor of hemorrhage, such as brainstem or deep-seated location and that fact that both surgical and radiosurgical interventions are effective in the prevention of bleeding, we constructed a valuable insight into cavernoma management that should be considered when deciding the best treatment modality.
Partial medial clinoidectomy with optic canal roof drilling for clipping of ophthalmic artery aneurysms: how I do it
We present the technique of minimally invasive partial medial clinoidectomy with the unroofing of the optic canal for surgical clipping of OA aneurysms, and besides its pros and cons, we also discuss proper technical indications.
Books
Brain Arteriovenous Malformations: Pathogenesis, Epidemiology, Diagnosis, Treatment and Outcome
This book reviews the natural course of arteriovenous malformation (AVM) disease and the active treatment modalities. Based on these comparisons, treatment recommendation for AVM is articulated. Furthermore, the long-term efficacy of different treatment is discussed.
This book is written by an international group of European authors, and is aimed at neurovascular surgeons and neurosurgical residents.
Cavernomas of the CNS: Basic Science to Clinical Practice
This book presents a complete up-to date description of cavernoma disease together with its known biology, genetics and variable clinical presentation. It facilitates improved decision-making on surgical intervention by presenting different cases, highlighting the particular features of lesions such as anatomical location, eloquences of adjacent brain and type of presentation that are important when making decisions. In addition, the reader is brought up to speed with developments in the neuroimaging and active treatment techniques, especially surgical resection and radiosurgery. Finally, the natural history of the disease is taken into account and compared to the possible benefits of surgical treatment.
Cavernomas of the CNS: Basic Science to Clinical Practice provides a comprehensive overview from the fundamentals of this condition to special patient groups such as children and pregnant women. Therefore, it is an indispensable resource for neurovascular surgeons, neurosurgical residents and neurologists.
Normal Pressure Hydrocephalus: Pathophysiology, Diagnosis, Treatment and Outcome
This book provides a detailed practically focused guide on the latest diagnostic and treatment techniques available for normal pressure hydrocephalus (NPH). Chapters in this work cover the latest developments related to this condition. It introduces how to use a range of diagnostic modalities including magnetic resonance scanning along with how artificial intelligence and machine learning methodologies can be applied. Cases are presented to reinforce how the methods covered can be appropriately applied and guiding principles are also given to assist the reader in developing a thorough understanding of the topic. Potential complications and means of mitigating these are also described.
Normal Pressure Hydrocephalus is a detailed practically applicable resource on NPH with insightful contributions covering relevant aspects of pathophysiology, diagnostic modalities and treatment strategies, making it an ideal resource for all medical practitioners who encounter these patients.