Artikel
Clinical course of disease 3 years after surgery in patients with idiopathic normal pressure hydrocephalus
Der klinische Verlauf von Patienten mit idiopathischem Normaldruckhydrozephalus 3 Jahre nach Shunt-Operation
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Especially in patients with idiopathic normal pressure hydrocephalus (iNPH) conventional differential-pressure valves are known to create unphysiological negative intraventricular pressure values (IVP), when the patient moves into the upright position, with the consequence of numerous, sometimes severe complications. The recently presented gravitational devices promise improvement primarily in respect to this disadvantage.
Methods
In a prospective study the Miethke Dual-Switch valve (M-DSV) was implanted in 60 patients with iNPH. The patients were assessed prior to operation, at discharge and re-evaluated 1 year after surgery. Fifty patients were re-evaluated 3 years (interval: 1,5 - 6 years) after operation. The technical principle of the device is presented.
Results
The clinical follow-up showed excellent or good results in 62% of the patients, satisfactory results in 14% and a poor outcome in 24% of the cases. The outcome correlated with the preoperative severity of NPH. Despite the clinical outcome, the CT-scans showed nearly no (or only a minimal) reduction of the ventricular size in the majority of cases. We found a valve-related rate of overdrainage of 3% which is clearly lower than results of comparable series in the literature. The valve-related rate of underdrainage was 10%, and the infections rate 3%.
Conclusions
The clinical course of patients suffering from iNPH is mainly influenced by the stage of the disease, the time of beginning the therapy and the gravitational function of the implanted device. Based on our clinical experiences with the M-DSV we underline the advantages of this valve for the treatment of hydrocephalus especially for patients with iNPH.