Article
proSA: The role in the management of iNPH
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Authors
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Edgar Rodolfo Lopez-Navarro
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum Neubrandenburg
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Michael J. Fritsch
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum Neubrandenburg
| Published: | June 2, 2015 |
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Outline
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Objective: Overdrainage is a common complication after VP-Shunt implantation. According to the SVASONA study gravitational valves reduce the incidence of overdrainage significantly. One indication for the implantation of the adjustable gravitational valve proSA is the treatment of complications related to overdrainage (e. g. subdural hygroma) in patients who already have a shunt. Another indication is the prevention of overdrainage in patients who have large ventricles and receive a VP-Shunt. A further indication, which had not been reported so far, is long-term adjustment of patients with iNPH and a pre-existing VP Shunt. Three to five years after initial implantation patients will likely experience worsening of their clinical symptoms and will benefit from lowering the opening pressure of their valve. Once the valve had been adjusted to a very low opening pressure (2 cm of water or zero) we continue treatment by lowering the opening pressure oft the proSA to 18, 16 or 14 cm of water. The goal of this pilote study is to evaluate safety and clinical outcome of this measure.
Method: Between September 2011 and August 2014 a total of 33 patients (17 female, 16 male, mean age 52) received a proSA at our institution. We divided the indication for proSA implantation in three groups: treatment of overdrainage (n=11), prevention of overdrainage (n=4) and optimization of the iNPH adjustment n=18. Follow-up ranged from 3 to 39 months (mean 15 months). Patients had regular outpatient visits and received a clinical examination, including Kiefer score.
Results: None of the 18 patients experienced overdrainage after adjusting the proSA to an opening pressure below 20 cm of water column. One patient was adjusted to 14 cm, three to 18 cm and the remaining 14 patients to 16 cm. All of those patients had an opening pressure of the valve of either zero or two cm of water column. In 12 out of 18 patients we achieved clinical improvement by stepwise lowering the proSA opening pressure, in 6 patients no improvement was seen.
Conclusions: The implantation of an adjustable gravitational valve (proSA) is a good therapy option not only for patients with signs of overdrainage or for patients with high risk for overdrainage. ProSA it is also a safe and reliable tool for the adjustment and clinical finetuning of patients with iNPH in long-term follow-up.
