Artikel
Clinical course of disease 3 years after surgery in patients with idiopathic normal pressure hydrocephalus
Kranheitsverlauf 3 Jahre nach Shuntoperation bei Patienten mit idiopathischem Normaldruckhydrozephalus
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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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, resulting in 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 and after the operation and re-evaluated 1 year after surgery. 50 patients were re-evaluated 3 years (interval 1 to 5 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 an only minimal reduction of the ventricular size in the majority of the cases. We found a valve-related rate of overdrainage of 3% wich is clearly lower than results of comparable series in the literature. The valve-related underdrainage was 10%, and the infections rate 3%.
Conclusions
The clinical course of of patients suffering from iNPH is mainly influenced by the stage of disease, the start of 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.