Craniosacral Therapy Use in Normal Pressure Hydrocephalus

Participants

• Number: 1

• Description: a 78-year-old male. Who had already been an osteopathic patient for more than 10 years, with a medical history of diabetes mellitus, hypertension, hyperlipidemia and stroke – in 2013 – with following left hemiparesis, mainly in the lower limbs, from which he had fully recovered.

In the past two years, he had developed a short-stepped shuffling gait with hesitation when turning and swaying only to the right side while walking with a cane. He would also freez while walking, due to a sense of lack of balance and was afraid of falling to the right. He also presented nocturia with bladder frequency and urgency and subjective memory difficulties, although with no signs of dementia.

The most recent MRI showed diffuse and stable ventriculomegaly of mild to moderate grade. As a result, a neurologist issued a diagnosis of normal pressure hydrocephalus and referred him to a neurosurgeon to perform a surgical shunt.
Faced with the invasiveness of the surgery, the patient decided to first try craniosacral therapy.

Interventions and evaluations

• Evaluation of gait-related symptoms.
• 15-minute sessions, first 3 weekly, then fortnightly and then monthly as maintenance.
• OMT:
  • Craniosacral therapy: fourth ventricle compression and venous sinus drainage.

Results

The first therapy session was well tolerated, and in the following days, the patient noticed a significant improvement in his gait, although the situation slightly worsened after one week. After the second session, a new improvement occurred. After the third session, his gait was significantly improved and the patient could turn 90° without any particular hesitation.

Although his walking was still aided by the use of the cane, the patient was able to walk faster and began to feel more comfortable walking in crowded environments. In addition, the bladder situation also showed improvement.

Subsequent sessions helped manage gait-related symptoms.

A new MRI performed in 2021, 3 months after the start of therapy and 12 months after the previous MRI, showed no significant changes in ventriculomegaly. However, craniosacral therapy favored a reduction of the symptoms.

Discussion

In this study, craniosacral therapy was shown to be able to reduce symptoms in a case of normal pressure hydrocephalus. Although post-therapy MRI showed no change, some studies show that the evolution of the size and degree of atrophy of the ventricles does not correlate with the patient’s response to therapy.

Craniosacral therapy uses light touch to assess and balance restrictions at the level of the craniosacral system by evaluating the flow of cerebrospinal fluid-which resembles a respiratory rhythm-and the positioning of the cranial bones. A special role in craniosacral therapy is played by compression of the fourth ventricle, which aims to balance sympathetic and parasympathetic autonomic activity. Indeed, by applying pressure to the occiput, the osteopath can influence the cranial rhythmic impulse and help the movement of cerebrospinal fluid, thus reducing possible congestion of the ventricles. For the same purpose, venous sinus drainage is also an especially used technique: in fact, a previous efficacy study had shown that this technique can improve hemodynamics (as measured by ultrasounds) at the cranial base, thus being able to promote cerebrospinal fluid reabsorption.

Although this study treats a single case, the results may be useful in considering craniosacral therapy as a possible alternative to invasive interventions in the case of normal tension hydrocephalus. Of course, more in-depth studies are needed to investigate these results further.