Artikel
On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal-pressure hydrocephalus: a prospective study with 122 patients
Zum optimalen Öffnungsdruck hydrostatischer Ventile beim idiopathischen Normaldruckhydrozephalus: eine prospektive Studie mit 122 Patienten
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Does the opening pressure of hydrostatic shunts influence the clinical outcome for patients suffering from idiopathic normal-pressure hydrocephalus?
Methods
Between September 1997 and January 2003, 122 patients with idiopathic normal-pressure hydrocephalus (iNPH) were surgically treated by implanting a hydrostatic shunt at the Departments of Neurosurgery of the Unfallkrankenhaus Berlin and the University Homburg/Saar. The results of the clinical examination, the intrathecal infusion test and the cerebrospinal tap test served as decision aids concerning the shunt implantation. As part of a prospective study, all patients were examined preoperatively, postoperatively and 1 year after the intervention.
Results
43% of the patients showed a very good outcome, 25% a good outcome, 20% a fair outcome and 12% a poor outcome 1 year after the shunt implantation. Patients treated with an opening pressure rating of 50 mm H2O in the low-pressure stage of the gravitational valve showed a statistically significant better outcome than those with an opening pressure rating of 100 or 130 mm H2O. Of the valve-independent complications observed after the intervention (11% shunt-related complications), 8 (7%) were dislocations of ventricular or abdominal catheters, 3 (2%) were catheter tear-offs and 3 (2%) were shunt infections. Of the valve-related complications (10%), 4 patients (3%) suffered underdrainage, 8 patients (7%) showed radiological signs of overdrainage and 4 patients (3%) showed symptomatic overdrainage.
Conclusions
According to present knowledge, hydrostatic shunts with an opening pressure of 50 mm H2O for the low-pressure stage are the optimal therapy option for patients with iNPH. Due to the prompt switching function as soon as the patient changes his posture (lying down, standing, sitting, slanting etc.), the Miethke Gravity Assisted valve (GAV) Aesculap® is more suitable for such cases than the Miethke DualSwitch valve (DSV) Aesculap®. Can programmable gravitational valves contribute to a further optimization of the outcome while minimizing the valve-related complications?