Mangalore Sandhya, Rakshith Srinivasa, Srinivasa Rangashetty
Department of Neuroimaging and Interventional Radiology, NIMHANS, Bengaluru, Karnataka, India.
Department of Neuroradiology, MSR INS, Bengaluru, Karnataka, India.
Asian J Neurosurg. 2019 Apr-Jun;14(2):440-452. doi: 10.4103/ajns.AJNS_252_18.
Idiopathic intracranial hypertension (IIH) and normal pressure hydrocephalus (NPH) represent a cluster of typical clinical and imaging findings, with no evident etiological cause noted. In this study, we have proposed a model for IIH and NPH called Monroe-Kellie 3.0 (MK 3.0). IIH and NPH may be entities which represent opposite sides of the same coin with venous system and cerebrospinal fluid (CSF) as core drivers for both these entities.
IIH and NPH volume data were collected, voxel-based morphometry analysis was performed without normalization, and the distribution of the individual volumes of gray matter, white matter, and CSF was statistically analyzed. Visual morphometry analyses of segmented data were performed, and the findings in routine magnetic resonance imaging (MRI) were noted to build a model for IIH and NPH.
In IIH and NPH when the volumes were compared with controls, the distribution was similar. Furthermore, the morphometric changes noted in the MRI and segmented volume data were analyzed and the results were suggestive of changes in elastic property of brain causing a remodeling of brain shape and resulting in minor brain shift in the skull vault, and the resulting passive displacement of CSF which has been termed as MK 3.0.
This model helps to put the clinical and imaging findings and complications of treatment in single perspective.
特发性颅内高压（IIH）和正常压力脑积水（NPH）表现为一组典型的临床和影像学表现，病因尚不明确。在本研究中，我们提出了一种IIH和NPH的模型，称为Monroe - Kellie 3.0（MK 3.0）。IIH和NPH可能是同一硬币的两面，静脉系统和脑脊液（CSF）是这两种疾病的核心驱动因素。
收集IIH和NPH的体积数据，进行基于体素的形态计量学分析且不进行归一化处理，并对灰质、白质和脑脊液的个体体积分布进行统计分析。对分割后的数据进行视觉形态计量学分析，并记录常规磁共振成像（MRI）的结果，以建立IIH和NPH的模型。
在IIH和NPH中，当将体积与对照组进行比较时，分布相似。此外，对MRI和分割体积数据中记录的形态计量学变化进行了分析，结果提示脑弹性特性的改变导致脑形态重塑，并导致颅腔内轻微的脑移位，以及由此产生的脑脊液被动移位，这被称为MK 3.0。
该模型有助于从单一角度看待临床和影像学表现以及治疗并发症。
