J.Jpn. Surg. Soc.. 79(8): 884-889, 1978

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Report on the annual meeting

PATHOGENESIS AND TREATMENT OF NORMAL PRESSURE HYDROCEPHALUS
－FROM THE NEUROSURGICAL VIEWPOINT－

1. The syndrome of normal pressure hydrocephalus (NPH) includes the clinical triad of dementia, abnormal gait, and urinary incontinence, associated with hydrocephalus and normal cerebrospinal fluid (CSF) pressure, and it responds effectively to CSF shunting. Diagnostic criteria currently includes a pneumoencephalogram demonstrating communicating hydrocephalus with little or no air over the convexities, and RISA cisternogram indicating absent or delayed CSF flow over the convexities, with reflux into the ventricular system.
2. A series of 30 cases of NPH treated with CSF shunting were analyzed. All the currently accepted clinical and lavoratory criteria were met in our patients, yet in 7 cases of them the disease failed to abate after shunting procedure.
3. Constant intraventricular pressure monitoring has provided that CSF pressure is elevated, although intermittently, episodically and usually nocturnally. Compensation for raised pressure involves ventricular dilation, but also allows the flow of CSF to become reestablished with subsequent reduction of pressure.
4. Before and during lumbar saline infusion, epidural pressure and brain interstitial fluid pressure (BIFP) were monitored. BIFP were momitored both in the periventricular area and in the cortex. BIFP difference between the periventricular area and the cortex might be attributed to the episodically raised CSF pressure allowing the flow of CSF to the periventricular area. The raised BIFP in the periventricular area might contribute to the reduction of the regional cerebral blood flow, because of the reduction of the cerebral perfusion pressure.
I believe that the good response of CSF-shunting is probably due to the abolishment of CSF puls pressure and to the improvement of the regional cerebral blood flow.

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