Abstract
BACKGROUNDTreating idiopathic normal pressure hydrocephalus (iNPH) with lumboperitoneal shunts (LPSs) may cause cerebrospinal fluid (CSF) overdrainage.OBJECTIVETo investigate whether LPSs, including gravitational “add-on” and programmable pressure valves (PPVs/+GVs), reduce complications and improve outcomes.METHODSWe compared PPVs/+small lumen abdominal catheters (SLs) to PPVs/+GVs using different opening pressures for supine and standing positions. We analyzed 115 patients with iNPH in 2 consequent cohorts: 48 patients receiving LPSs with PPVs/+SLs and 67 patients receiving LPSs with PPVs/+GVs. The modified Rankin Scale (mRS), Japan iNPH grading scale, Mini Mental State Examination, Frontal Assessment Battery, and CSF biomarkers were evaluated.RESULTSComparisons of postoperative clinical factors in 64 patients in the PPV/+SL and PPV/+GV groups using 1:1 propensity score matching revealed differences in the mean (±standard deviation) postoperative mRS (2.65 ± 1.07 vs 2.16 ± 1.02, P = .049) and gait disturbance scores (1.97 ± 1.03 vs 1.39 ± 0.92, P = .011). Thus, outcomes improved in the LPS group with the GV. Serious and nonserious adverse event rates for the PPV/+SL and PPV/+GV groups were 22.9% and 19.4% (P = .647) and 38% and 17.9% (P = .018), respectively, indicating higher rates of subdural collections for the PPV/+SL group.CONCLUSIONThis is the first study to examine LPS treatment for iNPH using a GV in tandem with a PPV. Our results suggest that the CSF shunt flow volume is restricted in the standing position and maintained in the supine position, thus improving iNPH symptoms. This may reduce intracranial CSF hypotension-related complications.
Highlights
Treating idiopathic normal pressure hydrocephalus with lumboperitoneal shunts (LPSs) may cause cerebrospinal fluid (CSF) overdrainage
A previous study reported that patients with idiopathic normal pressure hydrocephalus (iNPH) require a mean (±standard deviation [SD]) vertical effective opening pressure of the entire shunt system of 27.5 ± 3.3 cmH2O, while patients with congenital hydrocephalus require a pressure of 36.3 ± 23.3 cmH2O, and patients with malresorptive hydrocephalus require a pressure of 35.9 ± 20.4 cmH2O.22
The results of the experiment indicated that gravitational addon valve (GV) placed into a column in sequence limit CSF flow to a greater extent while the patient is in the standing position, and maintain flow while the patient is in the supine position (Figures 1 and 2)
Summary
Treating idiopathic normal pressure hydrocephalus (iNPH) with lumboperitoneal shunts (LPSs) may cause cerebrospinal fluid (CSF) overdrainage. OBJECTIVE: To investigate whether LPSs, including gravitational “add-on” and programmable pressure valves (PPVs/+GVs), reduce complications and improve outcomes. METHODS: We compared PPVs/+small lumen abdominal catheters (SLs) to PPVs/+GVs using different opening pressures for supine and standing positions. We analyzed 115 patients with iNPH in 2 consequent cohorts: 48 patients receiving LPSs with PPVs/+SLs and 67 patients receiving LPSs with PPVs/+GVs. The modified Rankin Scale (mRS), Japan iNPH grading scale, Mini Mental State Examination, Frontal Assessment Battery, and CSF biomarkers were evaluated. Our results suggest that the CSF shunt flow volume is restricted in the standing position and maintained in the supine position, improving iNPH symptoms. This may reduce intracranial CSF hypotension-related complications
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