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Brain volume changes in spontaneous intracranial hypotension: Revisiting the Monro-Kellie doctrine.
Wu, Jr-Wei; Wang, Yen-Feng; Hseu, Shu-Shya; Chen, Shu-Ting; Chen, Yung-Lin; Wu, Yu-Te; Chen, Shih-Pin; Lirng, Jiing-Feng; Wang, Shuu-Jiun.
Afiliación
  • Wu JW; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Wang YF; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Hseu SS; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
  • Chen ST; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Chen YL; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
  • Wu YT; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Chen SP; Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Lirng JF; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Wang SJ; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
Cephalalgia ; 41(1): 58-68, 2021 01.
Article en En | MEDLINE | ID: mdl-32847387
ABSTRACT

OBJECTIVES:

In the application of the Monro-Kellie doctrine in spontaneous intracranial hypotension, the brain tissue volume is generally considered as a fixed constant. Traditionally, cerebral venous dilation is thought to compensate for decreased cerebrospinal fluid. However, whether brain tissue volume is invariable has not yet been explored. The objective of this study is to evaluate whether brain tissue volume is fixed or variable in spontaneous intracranial hypotension patients using automatic quantitative methods.

METHODS:

This retrospective and longitudinal study analyzed spontaneous intracranial hypotension patients between 1 January 2007 and 31 July 2015. Voxel-based morphometry was used to examine brain volume changes during and after the resolution of spontaneous intracranial hypotension. Brain structure volume was analyzed using Statistical Parametric Mapping version 12 and FMRIB Software Library v6.0. Post-treatment neuroimages were used as surrogate baseline measures.

RESULTS:

Forty-four patients with spontaneous intracranial hypotension were analyzed (mean [standard deviation] age, 37.8 [8.5] years; 32 female and 12 male). The whole brain tissue volume was decreased during spontaneous intracranial hypotension compared to follow-up (1180.3 [103.5] mL vs. 1190.4 [93.1] mL, difference -10.1 mL [95% confidence interval -18.4 to -1.8 mL], p = 0.019). In addition, ventricular cerebrospinal fluid volume was decreased during spontaneous intracranial hypotension compared to follow-up (15.8 [6.1] mL vs. 18.9 [6.9] mL, difference -3.2 mL [95% confidence interval -4.5 to -1.8 mL], p < 0.001). Longer anterior epidural cerebrospinal fluid collections, as measured by number of vertebral segments, were associated with greater reduction of ventricular cerebrospinal fluid volume (Pearson's r = -0.32, p = 0.036).

CONCLUSION:

The current study found the brain tissue volume and ventricular cerebrospinal fluid are decreased in spontaneous intracranial hypotension patients. The change in ventricular cerebrospinal fluid volume, but not brain tissue volume change, was associated with the severity of spinal cerebrospinal fluid leakage. These results challenge the assumption that brain tissue volume is a fixed constant.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Hipotensión Intracraneal Tipo de estudio: Observational_studies Idioma: En Revista: Cephalalgia Año: 2021 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Hipotensión Intracraneal Tipo de estudio: Observational_studies Idioma: En Revista: Cephalalgia Año: 2021 Tipo del documento: Article