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

Is there any use in shunting elderly patients over eighty years?

Ist eine Shunt-Anlage bei Patienten im hohen Lebensalter von über achtzig Jahren noch sinnvoll?

Meeting Abstract

Suche in Medline nach

  • corresponding author Niels Langer - Neurochirurgische Klinik, Universitäts-Krankenhaus Hamburg-Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitäts-Krankenhaus Hamburg-Eppendorf, Hamburg
  • U. Kehler - Neurochirurgische Klinik, Universitäts-Krankenhaus Hamburg-Eppendorf, Hamburg

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.02.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0031.shtml

Veröffentlicht: 23. April 2004

© 2004 Langer 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

VP-Shunts for hydrocephalus are safe procedures. However, complication like infections, dysfunctions do occur frequently. Therefore a benefit / risk-analysis must precede every surgery, especially in very old (>80y), probably more vulnerable patients. To answer the question if VP-shunting in this special subgroup is worthwhile, we analysed our patients operated upon the last 17 years.

Methods

Thirteen patients with a medium age of 84.4 years (80 - 95 years) suffering from chronic hydrocephalic symptoms were treated with a shunt in our clinic from 1985 to 2002. The data were retrospectively analysed for aetiology and the hydrocephalic triad symptoms staged with a clinical index-score (no, mild, intermediate and severe (0-3)) preoperatively and at follow-up presentation of the patient at our clinic or at the general practitioner. Every shunt-associated complication was noted.

Results

Apart from idiopathic hydrocephalus (4x) we found as underlying causes subarachnoidal haemorrhages (5x), tumours (3x) as well as trauma (1x). After surgery a clinical improvement was, in all cases before demission, notable. The severity score declined generally in all three main symptoms (pre-op > post-op): Gait disorders (2,7 > 2,0), cognitive impairment (2,3 > 1,8), urinary incontinence (1,5 > 1,2), overall (2,2 > 1,7). The main symptom gait disorders improved sooner and more substantially. In three cases the improvement lasted only a short time though a malfunction of the shunt-system could be excluded. In one of these cases the deterioration was probably caused by progress of a tumour located in the pineal region. We saw two overdrainages with consecutive subdural hygromas that needed to be operated upon but no shunt-revisions were necessary, no infections occurred.

Conclusions

Shunting has turned out to be a safe and effective procedure in our series even though there is a high co-morbidity in the elderly. We conclude that it is justifiable to treat this special subgroup of patients because the results are comparable to younger patients. Nevertheless careful decision making regarding the indications for shunting remains mandatory.