gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Shunt indication: Still enigmatic

Shunt-Indikation: immer noch rätselhaft

Meeting Abstract

Suche in Medline nach

  • corresponding author Michael Kiefer - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, 66421 Homburg-Saar
  • R. Eymann - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, 66421 Homburg-Saar
  • W. I. Steudel - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, 66421 Homburg-Saar

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.02.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0026.shtml

Veröffentlicht: 23. April 2004

© 2004 Kiefer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

The policy to indicate treatment in chronic hydrocephalus is still confusing. To evaluate the value of the resistance to outflow (ROF) and in contrast to that the influence of typical Co-morbidity in elderly we performed a prospective study.

Methods

From 1997 - 2003 in 125 patients with chronic hydrocephalus a dynamic infusion test was performed. In all patients a meticulous search of the medical history was performed. The types of co-morbidity were valued with 1 - 3 points and the sum of all points represented the general risk factor of co-morbidity (GRC) of each patient. The indication for shunt surgery based on ROF. All patients received a gravitational valve and were followed-up regularly. The clinical state pre- and postoperatively was assessed using the Homburger-Hydrocephalus Scale (HHS). All statistics were done at a significance level of 5%.

Results

The mean follow-up was 46 ± 16 months. 2/3 of the patients suffered from a normal pressure hydrocephalus, the others from a non-communicating hydrocephalus. About 80% of the patients made a good or excellent recovery, while 12% were non-responder. Using Pearson`s Correlation coefficient we could not establish any correlation between ROF and outcome. However when using a CHI-square test, a critical value of 23 mm Hg x ml / min may be found separating favourable (good or excellent) and not favourable outcome. In contrast to the weak correlation between ROF and outcome, the predictive value of GRC was highly significant. Pearson's correlation coefficient indicated a strong negative influence of the co-morbidity on the outcome.

Conclusions

While ROF was not found to be predictive for outcome, the newly created GCR allowed a clear judgement of the probable benefit after shunting. At a margin of 23 mm Hg x ml / min ROF may be used to separate patients with favourable and unfavourable outcome. The strategy of shunt indication should consider co-morbidity.