Patients of idiopathic normal-pressure hydrocephalus have small dural sac in cervical and upper thoracic levels: A supposed causal association.

Autor:	Kawahara T; Department of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan., Arita K; Department of Neurosurgery, Kagoshima University, Kagoshima, Japan., Fujio S; Department of Neurosurgery, Kagoshima University, Kagoshima, Japan., Higa N; Department of Neurosurgery, Kagoshima University, Kagoshima, Japan., Hata H; Department of Science, Kagoshima University, Kagoshima, Japan., Moinuddin FM; Department of Neurologic Surgery, Mayo Clinic, Rochester, United States., Hanaya R; Department of Neurosurgery, Kagoshima University, Kagoshima, Japan.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2023 Nov 10; Vol. 14, pp. 391. Date of Electronic Publication: 2023 Nov 10 (Print Publication: 2023).
DOI:	10.25259/SNI_474_2023
Abstrakt:	Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder presenting a triad including dementia and ventricular enlargement. The mechanism causing excessive cerebrospinal fluid (CSF) accumulation in the ventricles in iNPH is poorly understood. We hypothesized that the age-related degradation of the spinal shock-absorbing system composed of a spinal dural sac (SDS) and surrounding soft tissue, preventing ventricular enlargement caused by wide CSF pulsation driven by heartbeats, may be involved in the ventricular enlargement observed in iNPH. Methods: Sixty-four patients with iNPH in their seventies who underwent a lumboperitoneal shunt and a control group of 79 people in the same age group who underwent brain check-ups were included in the study. We compared the sizes of the cervical and upper parts of the thoracic SDS using magnetic resonance imaging between the two groups. Results: The anterior-posterior distances of the dural sac at C5 were shorter in patients with iNPH of both sexes than those in the control group ( P = 0.0008 in men and P = 0.0047 in women). The number of disc levels with disappeared CSF space surrounding the cervical cord was more in iNPH ( P = 0.0176 and P = 0.0003). The midsagittal area of the upper part of the spinal sac, C2-Th4, was smaller in iNPH ( P = 0.0057 and P = 0.0290). Conclusion: Narrowing of the cervical dural sac and midsagittal area in the upper part of the SDS in patients with iNPH may reflect the degradation of the shock-absorbing mechanism for CSF pressure pulsations, which may cause iNPH or at least aggravate iNPH by other unknown causes. Competing Interests: There are no conflicts of interest. (Copyright: © 2023 Surgical Neurology International.)
Databáze:	MEDLINE
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