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Lumbar elastance and resistance to CSF outflow correlated to patency of the cranial subarachnoid space and clinical outcome of endoscopic third ventriculostomy in obstructive hydrocephalus.
[hydrocephalus with stenosis of the aqueduct of sylvius]
The
purpose
of
the
present
study
was
to
elucidate
the
value
of
the
lumbar
and
intraventricular
infusion
tests
in
the
selection
of
patients
with
obstructive
hydrocephalus
(
OH
)
for
endoscopic
third
ventriculostomy
(
ETV
)
,
and
whether
the
presence
of
a
diminished
cranial
subarachnoid
space
was
a
source
of
error
in
the
interpretation
of
the
results
.
In
32
consecutive
adult
patients
(
15
M
,
17
F
,
mean
age
:
46
years
)
with
possible
treatment-requiring
OH
,
the
resistance
to
cerebrospinal
fluid
(
CSF
)
outflow
(
Rout
)
and
elastance
was
measured
with
a
lumbar
infusion
test
.
Eleven
of
the
patients
underwent
an
additional
intraventricular
infusion
test
.
An
ETV
was
subsequently
performed
in
20
patients
,
of
whom
11
presented
with
idiopathic
aqueductal
stenosis
and
9
with
other
various
causes
of
OH
.
T
he
presence
of
a
diminished
cranial
SAS
correlated
significantly
with
increased
lumbar
elastance
,
but
not
with
lumbar
Rout
.
However
,
distinctly
increased
Rout
values
(
>
24
mmHg
/
mL
/
min
,
n
=
4
)
were
only
measured
in
the
presence
of
a
diminished
cranial
SAS
.
No
significant
correlation
was
demonstrated
between
the
clinical
outcome
of
ETV
and
lumbar
elastance
or
lumbar
Rout
,
although
seven
out
of
the
eight
improving
patients
with
aqueductal
stenosis
presented
normal
lumbar
Rout
values
.
In
patients
undergoing
both
a
lumbar
and
an
intraventricular
infusion
test
and
improving
after
ETV
(
n
=
6
)
,
lumbar
elastance
was
significantly
increased
compared
to
the
intraventricular
elastance
.
A
diminished
cranial
SAS
correlates
with
increased
lumbar
elastance
and
may
explain
the
highly
increased
lumbar
Rout
values
,
possibly
by
impeding
the
bulk
flow
from
the
infusion
.
The
majority
of
patients
improving
after
ETV
and
presenting
a
normal
sized
cranial
SAS
presented
normal
lumbar
Rout
values
.
Supplementing
the
lumbar
infusion
test
with
an
intraventricular
test
may
help
in
predicting
the
outcome
of
ETV
.
Diseases
Validation
Diseases presenting
"hydrocephalus"
symptom
achondroplasia
alexander disease
canavan disease
congenital toxoplasmosis
harlequin ichthyosis
hirschsprung disease
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
krabbe disease
monosomy 21
proteus syndrome
severe combined immunodeficiency
sneddon syndrome
von hippel-lindau disease
wiskott-aldrich syndrome
This symptom has already been validated