[Neuroimaging predictors of favorable outcomes after shunting procedures in patients with Hakim-Adams syndrome: a pilot prospective randomized trial].

Abstract

Higher effectiveness of cerebrospinal fluid shunting procedures is still an unresolved issue in the treatment of idiopathic normal pressure hydrocephalus. Thus, over 15% of patients do not experience symptom regression in postoperative period. In recent years, several MRI predictors have been actively investigated to forecast the outcomes of cerebrospinal fluid shunting procedures. We have previously introduced a prognostic model for comprehensive evaluation of MRI data facilitating identification of patients likely to benefit from surgical intervention.

Objective: To evaluate diagnostic properties of MRI data comprehensive assessment model compared to traditional invasive diagnostic method (spinal tap test) in prospective randomized trial.

Material and methods: MRI data and postoperative outcomes in patients diagnosed with idiopathic normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between September 2022 and April 2024 were analyzed in prospective randomized study. In the study group, surgical decisions were based on MRI data, while the control group followed an algorithm incorporating invasive diagnostic method (spinal tap-test). Ventriculoperitoneal shunting with constant-pressure valve implantation was performed in all patients selected for surgery.

Results: The study included 54 patients (25 ones in the study group and 29 ones in the control group). Surgery was performed in 21 and 20 patients, respectively. We found no advantages of invasive diagnostic methods over comprehensive assessment of MRI data in predicting the effectiveness of surgical treatment.

Conclusion: Comprehensive assessment of MRI findings allows for avoiding invasive diagnostic procedures in decision-making on cerebrospinal fluid shunting surgery in some patients with idiopathic normal pressure hydrocephalus.