Comparison of Noninvasive Measurements of Intracranial with Tap Test Results in Patients with Idiopathic Normal Pressure Hydrocephalus

Gabriel André da Silva Mendes,1,2 Cintya Yukie Hayashi,2,3 Gustavo Henrique Frigieri Vilela,3 Lissa Kido,3 Manoel Jacobsen Teixeira,2 Fernando Campos Gomes Pinto2 1Physiotherapy Nucleous, Hospital of the State Public Servant of São Paulo, São Paulo City, São Paulo State, Brazil; 2Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil; 3Braincare Desenvolvimento e Inovação Tecnológica S.A, São Carlos City, São Paulo State, BrazilCorrespondence: Gabriel André da Silva Mendes, Email [email protected]: Normal pressure hydrocephalus is a disease directly related to the change in intracranial compliance and consequent repercussions in the brain parenchyma. Invasive monitoring of such parameters proves to be reliable especially for prognosis in neurocritical patients; however, it is not applicable in an outpatient service setting. The present study describes the comparison between the tap test results and the parameters obtained with a non-invasive sensor for monitoring intracranial compliance in patients with suspected NPH.Methods: Twenty-eight patients were evaluated before and after lumbar puncture of 50mL of CSF (the tap test), comprising clinical assessment, magnetic resonance imaging, physical therapy assessment using the Timed Up and Go test, Dynamic Gait Index, BERG test, neuropsychological assessment, and recording of non-invasive intracranial compliance data using the Brain4care® device in three different positions (lying, sitting, and standing) for 5 min each. The tap test results were compared to the Time to Peak and P2/P1 ratio parameters obtained by the device.Results: The group that had a positive Tap test result presented a median P2/P1 ratio greater than 1.0, suggesting a change in intracranial compliance. In addition, there was also a significant difference between patients with positive, negative, and inconclusive results, especially in the lying position.Conclusion: A non-invasive intracranial compliance device when used with the patient lying down and standing up obtained parameters that suggest correspondence with the result of the tap test.Keywords: normal pressure hydrocephalus, intracranial pressure, biomedical technology, cerebrospinal fluid pressur

Diagnosis of, surgical technique for and treatment results from medullary lipomas associated with spinal dysraphism: experience with 38 patients

OBJECTIVE: To observe whether microsurgical removal of medullary lipomas and untethering of the medulla is a safe and efficient procedure. METHOD: A retrospective study was carried out on 38 patients with medullary lipomas associated with spinal dysraphism who underwent operations between January 1986 and January 2008, at the Neurosurgery Department of the Federal Hospital for State Public Servants, in Rio de Janeiro. RESULTS: No deaths occurred in this series, and there was no worsening of motor or bladder function among the patients. Seven individuals presented improvements in their motor deficit. Nine patients presented improvements in bladder function. Three individuals with trophic lesions achieved wound healing. CONCLUSION: Microsurgical removal of medullary lipomas associated with spinal dysraphism proved to be a safe procedure without deaths and with a low morbidity rate, and several patients achieved improvements in their neurological symptoms