Use of the proGAV Shunt Valve in Normal-Pressure Hydrocephalus

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons245-ons249 ◽  
Author(s):  
Ahmed K. Toma ◽  
Andrew Tarnaris ◽  
Neil D. Kitchen ◽  
Laurence D. Watkins
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Pressure Setting ◽  
Adjustable Valve ◽  
Computed Tomography Scans ◽  
Clinical Records ◽  
The Brain

Abstract Background: Overdrainage is a common complication associated with shunt insertion in normal-pressure hydrocephalus (NPH) patients. Using adjustable valves with antigravity devices has been shown to reduce its incidence. The optimal starting setting of an adjustable shunt valve in NPH is debatable. Objective: To audit our single-center practice of setting adjustable valves. Methods: We performed a retrospective review of clinical records of all NPH patients treated in our unit between 2006 and 2009 by the insertion of shunts with a proGAV valve, recording demographic and clinical data, shunt complications, and revision rates. Radiological reports of postoperative follow-up computed tomography scans of the brain were reviewed for detected subdural hematomas. Results: A proGAV adjustable valve was inserted in 50 probable NPH patients between July 2006 and November 2009. Mean ± SD age was 76 ± 7 years. Mean follow-up was 15 months. The initial shunt setting was 6 ± 3 cm H2O, and the final setting was 4.9 ± 1.9 cm H2O. Nineteen patients required 24 readjustment procedures (readjustment rate, 38%; readjustment number, 0.48 times per patient). One patient (2%) developed delayed bilateral subdural hematoma after readjustment of his shunt valve setting as an outpatient. Conclusion: Starting with a low opening pressure setting on a proGAV adjustable shunt valve does not increase the chances of overdrainage complications and reduces the need for repeated readjustments.

scholarly journals The Impact of Selected Cytokines in the Follow-Up of Normal Pressure Hydrocephalus

2015 ◽  
pp. S283-S290 ◽  
Author(s):  
L. SOSVOROVA ◽  
M. MOHAPL ◽  
J. VCELAK ◽  
M. HILL ◽  
J. VITKU ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Neurodegenerative Disorders ◽  
Time Course ◽  
Normal Pressure ◽  
Shunt Insertion ◽  
Mediators Of Inflammation ◽  
The Impact ◽  
Surgical Shunt

Cytokines are widely known mediators of inflammation accompanying many neurodegenerative disorders including normal pressure hydrocephalus (NPH). NPH is caused by impaired cerebrospinal fluid (CSF) reabsorption and treated by surgical shunt insertion. The diagnostics is still complicated and the shunt effect is not durable; after several years, dementia may develop. In the clinical practice, biomarkers support the diagnostics as well as the further time course of many neurodegenerative diseases. Until recently, no reliable biomarker for NPH was evaluated. The attempt of this review was to make a survey concerning cytokines as possible NPH markers. Among all reviewed cytokines, the most promising are CSF IL-10 and IL-33, enabling to follow-up the disease progression and monitoring the effectiveness of the shunt insertion.

TM3-8 Use of adjustable anti-gravity devices in NPH patients with delayed post-shunt deterioration

2019 ◽  
Vol 90 (3) ◽  
pp. e17.1-e17
Author(s):  
JP Funnell ◽  
CL Craven ◽  
L D’Antona ◽  
L Thorne ◽  
LD Watkins ◽  
...  
Keyword(s):  
Neuropsychological Test ◽  
High Volume ◽  
Normal Pressure ◽  
Differential Pressure ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Temporary Shunt ◽  
Optimum Management

ObjectivesA subset of idiopathic Normal Pressure Hydrocephalus (NPH) patients respond to VP shunt insertion temporarily. Adjustable anti-gravity devices are designed to control position-induced CSF drainage changes; we aim to assess to effect of using these devices to achieve controlled overdrainage in temporary shunt responders.DesignA single-centre retrospective study of patients undergoing VP shunt valve revision from an adjustable differential pressure valve with fixed anti-siphon (ProGAV +Shuntassistant) to a system incorporating an adjustable anti-siphon valve (ProGAV +ProSA) (April 2013-April 2018).Subjects21 patients diagnosed with temporary shunt-responsive NPH who improved on high volume shunt reservoir tap (10M: 11F). Mean age at first VP shunt insertion was 74.5±7.87 years.MethodsMedical records were retrospectively reviewed for demographics, interventions and clinical outcomes.ResultsMean duration until revision with a ProSA valve was 31.5±16.8 months (mean ±SD). Mean follow up was 31.4±15.9 months. Of 20 patients with sufficient follow-up, 12 made objective improvements in walking and/or neuropsychological test outcome. 15 patients made subjective improvements in mobility or cognitive impairment.ConclusionsVP shunting with adjustable differential pressure valves and fixed antigravity devices may not drain sufficient CSF for optimum management of low pressure hydrocephalus. Addition of adjustable anti-gravity devices at lower shunt settings in temporary shunt responders may improve outcome.

scholarly journals Steroid Hormones and Homocysteine in the Outcome of Patients With Normal Pressure Hydrocephalus

2015 ◽  
pp. S227-S236 ◽  
Author(s):  
L. SOSVOROVA ◽  
M. MOHAPL ◽  
M. HILL ◽  
L. STARKA ◽  
M. BICIKOVA ◽  
...  
Keyword(s):  
Gas Chromatography ◽  
Cerebrospinal Fluid ◽  
Steroid Hormones ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Plasma Levels ◽  
Normal Pressure ◽  
Plasma Homocysteine ◽  
Shunt Insertion

Normal pressure hydrocephalus (NPH) is one of a few treatable conditions of cognitive decline affecting predominately elderly people. Treatment, commonly based on the ventriculoperitoneal shunt insertion, leads to a partial or complete correction of patient's state, although its effect does not unfortunately always last. The aim of our study was to observe the changes of homocysteine and selected steroids and neurosteroids and follow-up the patients with respect to the duration of the NPH-related dementia improvement. The cerebrospinal fluid and plasma levels of cortisol, cortisone, dehydroepiandrosterone (DHEA), 7α-hydroxy-DHEA, 7β-hydroxy-DHEA, 7-oxo-DHEA, 16α-hydroxy-DHEA (all LC-MS/MS), DHEA-sulphate (DHEAS) (radioimmunoassay) and homocysteine (gas chromatography) were determined in NPH-diagnosed subjects before, during and 6, 12 and 24 months after shunt insertion. The cognitive functions ameliorated after shunt insertion and remain improved within 2 years. Changes in cerebrospinal fluid DHEAS, DHEA and its ratio, cortisone/cortisol and 16α-hydroxy-DHEA and plasma DHEAS, 7β-hydroxy-DHEA, cortisone/cortisol and homocysteine were found. Mentioned changes may contribute to the clarification of NPH pathogenesis. Altered neurosteroids levels are possible indicators to be utilized in the follow-up of NPH subjects. Moreover, plasma homocysteine may serve as an early indicator of NPH-related dementia.

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

2014 ◽  
Vol 121 (5) ◽  
pp. 1257-1263 ◽  
Author(s):  
Terje Sæhle ◽  
Dan Farahmand ◽  
Per Kristian Eide ◽  
Magnus Tisell ◽  
Carsten Wikkelsö
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Improvement Rate ◽  
Vp Shunt ◽  
Shunt Complications ◽  
Pressure Setting ◽  
Randomized Controlled ◽  
Adjustable Valve ◽  
Significant Difference

Object This study was undertaken to investigate whether a gradual reduction of the valve setting (opening pressure) decreases the complication rate in patients with idiopathic normal-pressure hydrocephalus (iNPH) treated with a ventriculoperitoneal (VP) shunt. Methods In this prospective double-blinded, randomized, controlled, dual-center study, a VP shunt with an adjustable valve was implanted in 68 patients with iNPH, randomized into two groups. In one group (the 20–4 group) the valve setting was initially set to 20 cm H2O and gradually reduced to 4 cm H2O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium pressure setting of 12 cm H2O during the whole study period. The time to and type of complications (hematoma, infection, and mechanical problems) as well as overdrainage symptoms were recorded. Symptoms, signs, and outcome were assessed by means of the iNPH scale and the NPH grading scale. Results Six patients in the 20–4 group (22%) and 7 patients in the 12 group (23%) experienced a shunt complication; 9 had subdural hematomas, 3 mechanical obstructions, and 1 infection (no significant difference between groups). The frequency of overdrainage symptoms was significantly higher for a valve setting ≤ 12 cm H2O compared with a setting > 12 cm H2O. The 20–4 group had a higher improvement rate (88%) than the 12 group (62%) (p = 0.032). There was no significant relationship between complications and body mass index, the use of an antisiphon device, or the use of anticoagulants. Conclusions Gradual lowering of the valve setting to a mean of 7 cm H2O led to the same rate of shunt complications and overdrainage symptoms as a fixed valve setting at a mean of 13 cm H2O but was associated with a significantly better outcome.

Assessment of a Quick Reference Table Algorithm for Determining Initial Postoperative Pressure Settings of Programmable Pressure Valves in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 722-728 ◽  
Author(s):  
Hiroji Miyake ◽  
Yoshinaga Kajimoto ◽  
Hisayuki Murai ◽  
Sadahiro Nomura ◽  
Shigeki Ono ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Reference Table ◽  
Pressure Setting ◽  
Neurological Improvement ◽  
Low Pressure Headache ◽  
Pressure Headache ◽  
Programmable Valves

Abstract BACKGROUND: Management of overdrainage complications in shunted patients with idiopathic normal pressure hydrocephalus (INPH) remains a difficult task despite the use of programmable pressure valves. OBJECTIVE: To assess the usefulness of a quick reference table (QRT) algorithm for achieving a suitable initial programmable pressure valve setting in INPH patients who participated in the Study for INPH on Neurological Improvement (SINPHONI). METHODS: One hundred registered patients diagnosed with probable INPH were treated with ventriculoperitoneal shunts using Codman-Hakim programmable valves (CHPVs). In this series, the initial CHPV setting was decided prospectively according to the QRT algorithm. Shunt effectiveness, complications, and the number of CHPV readjustments during follow-up periods were investigated. RESULTS: Eighty patients were considered better than shunt responders (more than 1 point improvement in modified Rankin Scale at any follow-up period). Readjustments of CHPVs within 3 months after treatment with ventriculoperitoneal shunt were performed 56 times in 44 cases (44%, 0.56 times/patient). Low-pressure headache occurred in 9 patients, all of whom improved by readjustment alone. Nontraumatic subdural fluid collections and chronic subdural hematomas occurred in 15 cases (15%); however, most of the cases were subclinical and improved after CHPV readjustments alone. Burr hole irrigation was necessary in only 1 case. CONCLUSION: Use of the QRT algorithm was associated with a decrease in postoperative CHPV readjustments and serious overdrainage complications during the follow-up period. The QRT algorithm is an easy, safe, and effective method for determining the initial CHPV pressure setting in INPH patients.

scholarly journals Long term prognosis of ventriculoatrial shunt for idiopathic normal pressure hydrocephalus in the elderly

2017 ◽  
Vol 31 (4) ◽  
pp. 490-494
Author(s):  
Tsukasa Kawase ◽  
Kyosuke Miyatani ◽  
Riki Tanaka ◽  
Yasuhiro Yamada ◽  
Shamim Ul Haq Siddiqui ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Modified Rankin Scale ◽  
Shunt Insertion ◽  
Significant Difference ◽  
Long Term Prognosis

Abstract Objective: A retrospective study was conducted to access the long-term prognosis of inserting the Ventriculoatrial (VA) shunt in the elderly for the idiopathic normal pressure hydrocephalus (iNPH). Material and Methods: Retrospective data is collected from April 2004 to August 2015, and 1065 patients were selected. Patients who underwent surgical examination or surgery in suspected iNPH were included. Tap test is done in all cases and found to be effective for 968 cases and 656 VA shunts for 614 cases. Out of 614 cases there are 440 cases in which patient age were over 75 years. Of these 440 cases only 141 cases were able to observe 03 years or more after the surgery, 37 deaths and 05 cases with survival and unknown prognosis were found among them. So we analyzed this group mainly in 99 cases that the prognosis after 03 years was known. We access the outcome of VA shunt by the modified Rankin scale (mRS), iNPH grading scale (iNPHGS) and complications in the operative 656 cases and in 03 years follow up of 141 patients. Results: Of 141, there are 78 males and 63 females. Age at the time of VA shunt insertion was 81.5±4.1 years and age at final follow-up was 85.2±4.4 years. The proportion of patients who achieved a favorable outcome by complications was 97.9% in 03 years follow-up period and 87.7% in which follow-up is less than 03 years. At the time of VA shunt insertion out of 141, 57 patients lies between 75-79 years, 57 between 80-84, 24 between 85 to 89, and only 03 were found to be 90 years or more. At the time of final follow-up at 03 years, 15 patients lies between 75 to 79 years, 56 between 80 to 84 years, 57 between 85 to 89 years and 23 patents were found to be 90 years or greater. 70 cases or almost 50% exceeded 85 years. At the time of VA shunt 1, 11, 39, 51, 36, 3, 0 patients were in 0 to 6 modified Rankin Scale Score respectively and at 03 years follow-up 8, 19, 32, 29, 9, 2, 37 were in 0 to 6 mRS respectively. Comparison of the study is done with SIPHONI study on VP shunt and LP shunt. Conclusion: Patients suspected of having idiopathic normal pressure hydrocephalus were treated by VA shunt and found no significant difference in serious adverse effects. This study shows that VA shunt is an effective choice for iNPH in the late elderly population, but it needs more randomized control trial to establish its efficacy.

scholarly journals A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus

2016 ◽  
Vol 124 (2) ◽  
pp. 359-367 ◽  
Author(s):  
Dan Farahmand ◽  
Terje Sæhle ◽  
Per Kristian Eide ◽  
Magnus Tisell ◽  
Per Hellström ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Double Blind ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Significant Clinical Improvement ◽  
Medium Level ◽  
Double Blinded

OBJECT The study aim was to examine the effect of gradually reducing the opening pressure on symptoms and signs in the shunt treatment of idiopathic normal pressure hydrocephalus (iNPH). METHODS In this prospective double-blinded, randomized, controlled, double-center study on patients with iNPH, a ventriculoperitoneal shunt with an adjustable Codman Medos Valve was implanted in 68 patients randomized into 2 groups. In 1 group (the 20–4 group) the valve setting was initially set to 20 cm H2O and gradually reduced to 4 cm H2O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium level of 12 cm H2O during the whole study period. All patients were clinically evaluated using 4 tests preoperatively as well as postoperatively at 1, 2, 3, 4, and 6 months. The test scores between the 2 groups (20–4 and 12) were compared for each clinical evaluation. RESULTS Fifty-five patients (81%) were able to complete the study. There were no significant differences between the 2 groups (20–4 and 12) preoperatively or at any time postoperatively. Both groups exhibited significant clinical improvement after shunt insertion at all valve settings compared with the preoperative score, with the greatest improvement observed at the first postoperative evaluation. The clinical improvement was significant within the first 3 months, and thereafter no significant improvement was seen in either group. CONCLUSIONS Gradual reduction of the valve setting from 20 to 4 cm H2O did not improve outcome compared with a fixed valve setting of 12 cm H2O. Improvement after shunt surgery in iNPH patients was evident within 3 months, irrespective of valve setting.

Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

2021 ◽  
Author(s):  
Giuseppe Emmanuele Umana ◽  
Gianluca Scalia ◽  
Marco Fricia ◽  
Giovanni Federico Nicoletti ◽  
Domenico Gerardo Iacopino ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Temporal Muscle ◽  
Brain Computed Tomography ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Clinical Records ◽  
Dural Opening ◽  
Traditional Approaches ◽  
Scalp Incision

Abstract Background We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants. Methods We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients for acute subdural hematomas. All the patients were in therapy with antiplatelets or anticoagulants. Results Approach-related complications were not detected. Ten of 67 patients (14.9%) presented temporal muscle atrophy; there was no scar deformity, paresthesia, hyperalgesia, or ramus frontalis palsy around the scalp incision. Thirty-day mortality was 22%. The mean follow-up was 1.3 years. One-month postoperative brain computed tomography scans showed a satisfactory hematoma evacuation in 57 of 67 patients (85%). Conclusions The diamond-shaped mini-craniotomy for acute subdural and intracerebral hematomas is safe and effective, and it should be considered as an alternative to traditional approaches, particularly in elderly patients.

Impact of Cerebrovascular Disease on the Surgical Treatment of Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 545-552 ◽  
Author(s):  
Diego Spagnoli ◽  
Lucia Innocenti ◽  
Lorenzo Bello ◽  
Mauro Pluderi ◽  
Susanna Bacigaluppi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrovascular Disease ◽  
Vascular Disease ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Short Term ◽  
Long Term Follow Up ◽  
Short And Long Term

Abstract OBJECTIVE: The influence of cerebrovascular disease (CVD) on the short- and long-term results of surgery was evaluated in a series of consecutive patients with idiopathic normal-pressure hydrocephalus (iNPH). METHODS: Patients with suspected iNPH admitted to our department between June 1996 and June 2003 were evaluated with four clinical and handicap scales. CVD and risk factors for vascular disease were rated. All patients underwent intracranial pressure monitoring via a spinal catheter. Sixty-six patients received a ventriculoperitoneal shunt with a programmable valve. Prospective assessments were programmed at 2 weeks and 3 months after surgery (short-term follow-up). Long-term follow-up evaluations were arranged in June 2004 with patients and/or relatives and health/home care assistants. RESULTS: At the short-term follow-up examination, a significant clinical improvement was globally present in 89% of the patients (P < 0.05). CVD, such as leucoaraiosis or previous strokes, were present in 71% of the patients. Patients both with and without CVD and/or risk factors for vascular disease presented a significant improvement (P < 0.05) after shunting; 85 and 100% of the patients with and without CVD, respectively. At the long-term follow-up examination (mean, 52 ± 24.8 mo), 24% of the patients were dead and 8% had experienced stroke. Globally, 60% of the patients were still improved (P < 0.05); 52 and 79% of the patients with and without CVD, respectively. CONCLUSION: A high success rate in treatment of iNPH is possible in patients with and without CVD. Despite poorer short- and long-term treatment outcome of iNPH patients with CVD, a long-lasting improvement in their quality of life favors surgery.

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