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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

The quantitative effect of shunting in NPH

Hirndruckänderungen nach Shunt-Anlage beim NPH

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Sebastian Antes - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
  • Matthias Hülser - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
  • Joachim Oertel - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP111

doi: 10.3205/19dgnc447, urn:nbn:de:0183-19dgnc4479

Veröffentlicht: 8. Mai 2019

© 2019 Antes et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Ventriculoperitoneal shunting is considered being the gold standard in the treatment of normal pressure hydrocephalus (NPH). Sufficient cerebrospinal fluid (CSF) drainage is associated with a clear clinical improvement of cardinal symptoms; in most cases multiannual. However, while the clinical course of shunt-treated patients has been well studied, there is only few data focusing on the changes in intracranial pressure (ICP). Therefore, the aim of this study was to investigate different ICP parameters before and after shunt therapy.

Methods: A total of 63 NPH-patients with a mean age of 74.8±7.1 years (range, 52–91 years) underwent insertion of a telemetric ICP measurement device prior to the shunting procedure. Pre- and postoperatively gathered ICP data was statistically compared using the Wilcoxon signed-rank test. Target parameters were mean ICP (mICP), percentage of ICP values above the level of +10 mmHg (P10) and percentage of ICP values below the level of -5 mmHg (P-5).

Results: Sufficient CSF drainage and clinical improvement could be observed in 44 out of 63 patients. Three patients suffered postoperatively from underdrainage and 16 patients tended to overdrainage. Statistic comparison between the pre- and postoperative ICP target parameters showed significant differences (p<0.001) for mICP, P10 and P-5, both during day- and nighttime. P10 at night (-15.0%) and P-5 during daytime (+32.6%) represented the most remarkable quantitative changes. The changes in mICP were within the range of “normal pressure”.

Conclusion: For the first time in neurosurgical history, telemetry enabled the objectification of changes in ICP after shunting in a huge series of patients. Special parameters like P10 or P-5 seem to represent the quantitative effect of shunt therapy more adequately than the common mICP. Threshold values differentiating balanced drainage from over- or underdrainage remain to be evaluated.