Analysis of hearing loss after shunt placement in patients with normal-pressure hydrocephalus

2001 ◽  
Vol 95 (3) ◽  
pp. 432-434 ◽  
Author(s):  
Marie-Lise C. van Veelen-Vincent ◽  
Ernst J. Delwel ◽  
Rozemarijn Teeuw ◽  
Erkan Kurt ◽  
Dirk A. de Jong ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Normal Pressure ◽  
Shunt Insertion ◽  
Content Type ◽  
Shunt Placement ◽  
Fine Print

Object. Following shunt placement for treatment of normal-pressure hydrocephalus (NPH), several patients suffered hearing loss. The authors undertook a study to analyze this outcome. Methods. Sixteen patients in whom NPH was diagnosed were treated by placement of a ventriculoperitoneal shunt. Their hearing was assessed pre- and postoperatively by using pure tone audiometry. Two thirds of the ears tested showed a postoperative hearing loss of more than 10 dB. Recovery of the hearing loss occurred 6 to 12 weeks after shunt placement in 75% of the ears examined. Conclusions. Although shunt insertion for treatment of NPH results in a decrease in hearing, most of the loss can be recovered.

Is the placement of shunts in patients with idiopathic normal pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure

2004 ◽  
Vol 100 (5) ◽  
pp. 855-866 ◽  
Author(s):  
Maria A. Poca ◽  
Maria Mataró ◽  
Maria Del Mar Matarín ◽  
Fuat Arikan ◽  
Carmen Junqué ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Continuous Monitoring ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Symptom Duration ◽  
High Morbidity ◽  
Shunt Insertion ◽  
Content Type ◽  
Fine Print

Object. Data from many studies have demonstrated that shunt insertion in patients with idiopathic normal-pressure hydrocephalus (NPH) is associated with high morbidity and a lack of significant improvement; however, the use of strict diagnostic and treatment protocols can improve the results of surgery in these patients. The primary aim in this prospective study was to analyze the results of shunt placement in 43 patients with idiopathic NPH. A secondary aim was to determine the relationship between several clinical and neuroimaging factors, and patient outcome after surgery. Methods. Thirty men and 13 women with a mean age of 71.1 ± 6.9 years participated in this study. All patients underwent clinical, neuropsychological, and radiological assessment before and 6 months after surgery. In all patients continuous monitoring of intracranial pressure was performed using a fiberoptic extradural sensor. In 31 patients cerebrospinal fluid dynamics were also determined. Eighty-six percent of patients showed clinical improvement after shunt insertion, 11.6% showed no change, and 2.3% exhibited some worsening. Gait improved in 81.4% of the patients, sphincter control in 69.8%, and cognitive dysfunction in 39.5%. There was no treatment-related death. Early or late postsurgical complications occurred in six patients (14%), although all of these complications were minor or were satisfactorily resolved. The complete clinical triad, cortical sulci size, and periventricular lucencies were related to outcome, whereas patient age, symptom duration, ventricular dilation, and the degree of presurgical dementia were unrelated to outcome. Conclusions. Given the correct diagnosis, shunt insertion can produce marked improvement in patients with idiopathic NPH syndrome, causing few deaths and few clinically relevant complications.

Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus

2004 ◽  
Vol 100 (6) ◽  
pp. 1036-1040 ◽  
Author(s):  
Ullrich Meier ◽  
Sven Mutze
Keyword(s):  
Clinical Outcome ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Communicating Hydrocephalus ◽  
Ventricular Size ◽  
Content Type ◽  
Shunt Placement ◽  
Postoperative Change ◽  
Fine Print

Object. It is well known that in patients with communicating hydrocephalus or normal-pressure hydrocephalus (NPH), ventricular size decreases following implantation of shunts with differential pressure valves. The aim of this study was to determine whether ventricular size correlates with a positive clinical outcome following shunt placement. Methods. Hydrostatic valves (dual-switch valves) were implanted in 80 patients with NPH at Unfallkrankenhaus, Berlin, between September 1997 and January 2002. One year postoperatively, these patients underwent computerized tomography scanning, and their ventricular size was ascertained using the Evans Index. Among 80% of the patients who showed no postoperative change in ventricular volume, 59% nonetheless had good to excellent clinical improvements, 17% satisfactory improvement, and 24% no improvement. Furthermore, a moderate reduction in ventricular size was observed in 14% of patients in this cohort. Among these, 36% experienced good to excellent clinical improvements, 28% satisfactory improvement, and 36% unsatisfactory improvement. A marked reduction in ventricular size was observed in 6% of the patients. Of this latter group, 60% demonstrated good to excellent outcomes, whereas 40% had unsatisfactory outcomes. Conclusions. Favorable outcomes following the implantation of a hydrostatic shunt in patients with NPH did not correlate with decreased ventricular volume 1 year after surgery. In fact, better clinical outcomes were observed in patients with little or no alteration in ventricular size, compared with those in patients with a marked decrease in ventricular size. A postoperative change in ventricular volume should be assessed differently in patients with NPH compared with those suffering from hypertensive hydrocephalus.

Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement

2002 ◽  
Vol 97 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Richard C. Anderson ◽  
Jessica J. Grant ◽  
Robert de la Paz ◽  
Steven Frucht ◽  
Robert R. Goodman
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Ventricular Size ◽  
Content Type ◽  
Shunt Placement ◽  
Lateral Ventricles ◽  
Fine Print ◽  
Volumetric Measurements

Object. The syndrome of normal-pressure hydrocephalus (NPH) refers to the clinical triad of gait disturbance, dementia, and urinary incontinence in association with idiopathic ventriculomegaly and normal intracranial pressure. Ventriculoperitoneal (VP) shunt placement often yields significant clinical improvements, sometimes without apparent reduction of ventricular size. The authors hypothesized that careful volumetric measurements would show a decrease in ventricular volume in these patients. Methods. Twenty consecutive patients with NPH underwent placement of VP shunts equipped with programmable valves. In 11 patients pre- and postoperative neuroimaging was performed, which allowed volumetric analysis. Volumetric measurements of the lateral ventricles were calculated in triplicate by National Institutes of Health image-processing software to assess standard computerized tomography (CT) scans (eight patients) or magnetic resonance (MR) images (three patients) obtained before and after shunt placement. Ventricular volumes were also assessed by an independent neuroradiologist. Postoperative studies were performed at a time of clinical improvement, between 1 and 9 months postsurgery (mean 5 months). Preoperative and postoperative Unified Parkinson's Disease Rating Scale evaluations were performed in four patients. Significant clinical improvement occurred in all patients after shunt placement (mean follow-up period 17.5 months). Although 10 (91%) of 11 patients demonstrated a calculable decrease in volume in the lateral ventricles (mean decrease 39%), formal interpretation of neuroimages indicated a definite decrease in lateral ventricular volume in only three (27%) of 11 patients. Conclusions. Volumetric measurements obtained to compare preoperative and postoperative CT or MR studies obtained in patients with NPH in whom clinical improvement was seen after shunt placement surgery show a demonstrable decrease in ventricular size. Volumetric measurements may be helpful in clinical assessment postoperatively and in guiding programmable valve pressure settings.

The syndrome of normal-pressure hydrocephalus

1984 ◽  
Vol 61 (3) ◽  
pp. 501-509 ◽  
Author(s):  
John Vassilouthis
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Content Type ◽  
Postoperative Death ◽  
Shunting System ◽  
Fine Print

✓ A series of 40 patients with the syndrome of normal-pressure hydrocephalus is presented. Diagnosis was based on clinical and computerized tomography (CT) scan criteria and was followed by the insertion of a ventriculoperitoneal shunt in every instance. All patients responded favorably to treatment (four of them had a fair outcome), and this response was maintained. There was one postoperative death, but no other serious complications. This study demonstrates that it is possible to diagnose the syndrome of normal-pressure hydrocephalus on the basis of clinical and CT scan criteria without any other invasive investigations. Such patients should respond favorably to an adequately functioning shunting system.

Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts

1998 ◽  
Vol 88 (3) ◽  
pp. 490-495 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Content Type ◽  
Efficacy Analysis ◽  
Intention To Treat ◽  
Medium Pressure ◽  
Shunt Group ◽  
Fine Print

Object. The goal of this prospective study was to compare outcome after placement of a low- or medium-pressure shunt in patients with normal-pressure hydrocephalus (NPH). Methods. Ninety-six patients with NPH were randomized to receive a low-pressure ventriculoperitoneal shunt (LPV; 40 ± 10 mm H2O) or medium high—pressure ventriculoperitoneal shunt (MPV; 100 ± 10 mm H2O). The patients' gait disturbance and dementia were quantified by applying an NPH scale, and their level of disability was evaluated by using the modified Rankin scale (mRS). Patients were examined prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were determined by differences between preoperative and last NPH scale scores and mRS grades. The LPV and MPV shunt groups were compared by calculating both the differences between mean improvements and the proportions of patients showing improvement. Intention-to-treat analysis of mRS grades yielded a mean improvement of 1.27 ± 1.41 for patients with LPV shunts and 0.68 ± 1.58 for patients with MPV shunts (p = 0.06). Improvement was found in 74% of patients with LPV shunts and in 53% of patients with MPV shunts (p = 0.06) and a marked-to-excellent improvement in 45% of patients with LPV shunts and 28% of patients with MPV shunts (p = 0.12). All outcome measures indicated trends in favor of the LPV shunt group, with only the dementia scale reaching significance. After exclusion of serious events and deaths unrelated to NPH, efficacy analysis showed the advantage of LPV shunts to be diminished. Reduction in ventricular size was also significantly greater for patients in the LPV shunt group (p = 0.009). Subdural effusions occurred in 71% of patients with an LPV shunt and in 34% with an MPV shunt; however, their influence on patient outcome was limited. Conclusions. Outcome was better for patients who had an LPV shunt than for those with an MPV shunt, although most differences were not statistically significant. The authors advise that patients with NPH be treated with an LPV shunt.

Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 372-375 ◽  
Author(s):  
David C. McCullough ◽  
John L. Fox
Keyword(s):  
Intracranial Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Csf Shunts ◽  
Improvement Rate ◽  
Content Type ◽  
Subdural Hematomas ◽  
Significant Clinical Improvement ◽  
Fine Print

✓ Subdural hematomas and effusions have been noted in at least 20% of adult patients treated with CSF shunts for normal pressure hydrocephalus. In a series of 39 cases the incidence of this complication is correlated with the low 41% improvement rate. The very low intracranial pressure achieved with conventional shunt systems is probably the most important factor causing subdural collections of blood or fluid. In a study of pre- and post-shunt CSF pressures in 25 patients it was found that in the erect position ventriculoatrial and ventriculoperitoneal shunt systems produced pressures averaging —238 and —251 mm H2O respectively. Although the new antisiphon valves produced much smaller decrements of CSF pressure with significant clinical improvement in some cases, these units did not always prevent subdural hematomas.

Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease

1999 ◽  
Vol 90 (2) ◽  
pp. 221-226 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Cerebrovascular Disease ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Content Type ◽  
Shunt Placement ◽  
History Of ◽  
Intent To Treat ◽  
Fine Print

Object. This study was conducted to determine the prevalence of cerebrovascular disease and its risk factors among patients with normal-pressure hydrocephalus (NPH) and to assess the influence of these factors on the outcome of shunt placement.Methods. A cohort of 101 patients with NPH underwent shunt placement and was followed for 1 year. Gait disturbance and dementia were quantified using an NPH scale and handicap was determined using a modified Rankin scale (mRS). Primary outcome measures consisted of the differences between preoperative and last NPH scale and mRS scores. The presence of risk factors such as hypertension, diabetes mellitus, cardiac disease, peripheral vascular disease, male gender, and advancing age was recorded. Cerebrovascular disease was defined as a history of stroke or a computerized tomography (CT) scan revealing infarcts or moderate-to-severe white matter hypodense lesions.The prevalence of risk factors for cerebrovascular disease was higher in the 45 patients with cerebrovascular disease than the 56 without it. Risk factors did not influence outcome after shunt placement. Intent-to-treat analysis revealed that the mean improvement in the various scales was significantly less for patients with a history of stroke (14 patients), CT scans revealing infarctions (13), or white matter hypodense lesions (32 patients) than for those without cerebrovascular disease. The proportion of patients who responded to shunt placement was also significantly lower among patients with than those without cerebrovascular disease (p = 0.02).Conclusions. The authors identified a subgroup of patients with NPH and cerebrovascular disease who showed disappointing results after shunt placement. Cerebrovascular disease was an important predictor of poor outcome.

Cerebral hemodynamics in normal-pressure hydrocephalus

1984 ◽  
Vol 61 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Norihiko Tamaki ◽  
Tadaki Kusunoki ◽  
Toshimitsu Wakabayashi ◽  
Satoshi Matsumoto
Keyword(s):  
Computerized Tomography ◽  
Transit Time ◽  
Normal Pressure Hydrocephalus ◽  
Mean Transit Time ◽  
Contrast Material ◽  
Normal Pressure ◽  
Cerebral Hemodynamics ◽  
Content Type ◽  
Poor Outcome ◽  
Fine Print

✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting. Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.

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