Role of Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunt in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 845-854 ◽  
Author(s):  
Fernando Campos Gomes Pinto ◽  
Felippe Saad ◽  
Matheus Fernandes de Oliveira ◽  
Renan Muralho Pereira ◽  
Fernanda Letkaske de Miranda ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Functional Independence ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Third Ventriculostomy ◽  
Timed Up And Go ◽  
Programmable Valve ◽  
Significant Difference

Abstract BACKGROUND: Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation. OBJECTIVE: To compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS. METHODS: Randomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus. RESULTS: There was a statistically significant difference between the 2 groups after 12 months of follow-ups, and the VPS group showed better improvement results (ETV = 50%, VPS = 76.9%). CONCLUSION: Compared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Gait Disturbance ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Duration Of Symptoms ◽  
Cerebrospinal Fluid Flow

Abstract OBJECTIVE: To define the role and indications for an endoscopic third ventriculostomy (ETV) in patients with idiopathic normal pressure hydrocephalus (INPH). A series of 25 patients treated by endoscopic technique was analyzed, and the results were compared with those of 14 studies reporting patients treated by shunting. METHODS: Twenty-five patients with INPH were treated by ETV from January 1994 through December 2000. All were younger than 75 years of age, had a preoperative clinical history of 1 year or less, had prevalence of gait disturbance with scarce or mild dementia, had marked ventricular enlargement on magnetic resonance imaging (MRI), and had intracranial pressure values ranging from 8 to 12 mm Hg. All were studied by a phase-contrast MRI flow study 1 month after ETV. The 14 reviewed series of patients treated by shunting (all published after 1980) each include more than 25 patients, for a total of 777 patients. RESULTS: The overall rate of neurological improvement after ETV in our series was 72% (including two patients reoperated on because of absence of flow in the MRI scan); this percentage is slightly higher than that found in the 14 series of shunted patients (66%). Gait disturbance showed a high rate of improvement when compared with other symptoms, both in our ETV study and in other shunting series. Postoperative complications occurred only in one patient (4%) with an intracerebral frontal hemorrhage and in 37.9% of patients from the series including shunted patients. CONCLUSION: In patients with INPH showing short duration of symptoms, prevalence of gait disturbance, and slight mental impairment, ETV provides similar results to those of shunting. We suggest performing ETV in these patients and reserving shunting only for those who do not improve after ETV, despite the presence of cerebrospinal fluid flow through the ventriculostomy on MRI flow studies. The good results after ETV in our series indirectly confirm that the cerebrospinal fluid absorption is good or at least sufficient in selected patients with INPH.

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2005 ◽  
Vol 56 (5) ◽  
pp. E1166-E1166
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Third Ventriculostomy

scholarly journals Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus

2017 ◽  
Vol 7 (2) ◽  
pp. 98-108 ◽  
Author(s):  
Shigeki Yamada ◽  
Masatsune Ishikawa ◽  
Masakazu Miyajima ◽  
Madoka Nakajima ◽  
Masamichi Atsuchi ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Timed Up And Go ◽  
Tap Test ◽  
Lumboperitoneal Shunt ◽  
Shunt Implantation ◽  
Percent Improvement

AbstractBackground:The 3-meter Timed Up and Go test (TUG) is a reliable quantitative test for assessment of gait and balance. We aimed to establish an optimal threshold of TUG at the tap test for predicting outcomes 12 months after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:The TUG was measured in a total of 151 patients with possible iNPH before and after a tap test and 12 months after shunt surgery. Among them, 81 patients underwent ventriculoperitoneal shunt implantation (SINPHONI) and 70 underwent lumboperitoneal shunt implantation (SINPHONI-2). The areas under the curve (AUCs), sensitivities, and specificities for predicting shunt effectiveness were assessed.Results:The simple differences of time on TUG at the tap test were significantly more accurate for predicting shunt effectiveness than percent improvement of time. The highest AUC for the synchronized moving cutoff point of TUG time was 0.81 (sensitivity 81.0%; specificity 81.6%) at the threshold of 5 seconds in the SINPHONI-2. For predicting improvements of ≥10 seconds 12 months after lumboperitoneal shunt implantation, the AUC was 0.90, and the sensitivity and specificity at the threshold of 5.6 seconds were 83.3% and 81.0%. Only for patients with a <5-second improvement at the tap test, ventriculoperitoneal shunt implantation conveyed significantly better improvements in TUG time 12 months after surgery than lumboperitoneal shunt implantation.Conclusions:An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2005 ◽  
Vol 56 (5) ◽  
pp. E1166-E1166
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Third Ventriculostomy

ENDOSCOPIC THIRD VENTRICULOSTOMY IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 62-69 ◽  
Author(s):  
ichelangelo Gangemi ◽  
Francesco Maiuri ◽  
Michele Naddeo ◽  
Umberto Godano ◽  
Carmelo Mascari ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical History ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Third Ventriculostomy ◽  
Patient Age ◽  
Clinical Onset ◽  
Patient Âgé

ABSTRACT OBJECTIVES The aim of the report is to define the indications and results of endoscopic third ventriculostomy (ETV) in idiopathic normal pressure hydrocephalus and to discuss the physiopathological mechanism of this procedure. METHODS The cases of 110 patients with idiopathic normal pressure hydrocephalus who underwent ETV in four Italian neurosurgical centers were retrospectively reviewed. The postoperative outcome was correlated with patient age, length of clinical history, preoperative clinical score, symptoms of clinical onset, type of hydrocephalus, and intraoperative findings. RESULTS The follow-up period ranged from 2 to 12 years (average, 6.5 yr). The outcome evaluation was made 2 years after the procedure. Postoperative clinical improvement occurred in 76 (69.1%) of 110 patients. There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle). Conversely, the rate of neurological improvement was higher in patients with shorter clinical history, better preoperative neurological score, and clinical onset with gait disturbances. Moreover, the intraoperative finding of the sudden reappearance of normal cerebral pulsations and significant downward and upward movements of the third ventricular floor after ETV was also correlated with a good outcome. CONCLUSION ETV results in a relatively high rate of clinical improvement and a low complication rate in patients with idiopathic normal pressure hydrocephalus. Therefore, it may be easily performed with the same approach used for intracranial pressure monitoring with low morbidity. However, our data must be confirmed by additional studies.

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