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Indications for valve-pressure adjustments of gravitational assisted valves in patients with idiopathic normal pressure hydrocephalus.

Gölz L, Lemcke J, Meier U - Surg Neurol Int (2013)

Bottom Line: A total of 52 patients were provided with a Medos-Hakim valve(Codman®) with a Miethke shunt-assistant(Aesculap®) and 111 patients with a Miethke-proGAV(Aesculap®). 180 reductions of the valve-pressure took place (65% reactive, 35% planned).Optimal valve-pressure for most patients was around 50 mmH2O (36%).Planned reductions of the valve opening pressure are effective even if postoperative results are already satisfactory.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12686, Berlin, Germany.

ABSTRACT

Background: Modern ventriculoperitoneal shunts (VPS) are programmable, which enables clinicians to adjust valve-pressure according to their patients' individual needs. The aim of this retrospective analysis is to evaluate indications for valve-pressure adjustments in idiopathic normal pressure hydrocephalus (iNPH).

Methods: Patients operated between 2004 and 2011 diagnosed with iNPH were included. Kiefer-Scale was used to classify each patient. Follow-up exams were conducted 3, 6, and 12 months after shunt implantation and yearly thereafter. Initial valve-pressure was 100 or 70 mmH2O. Planned reductions of the valve-pressure to 70 and 50 mmH2O, respectively, were carried out and reactive adjustment of the valve-pressure to avoid over- and under-drainage were indicated.

Results: A total of 52 patients were provided with a Medos-Hakim valve(Codman®) with a Miethke shunt-assistant(Aesculap®) and 111 patients with a Miethke-proGAV(Aesculap®). 180 reductions of the valve-pressure took place (65% reactive, 35% planned). Most patients (89%) needed one or two adjustments of their valve-pressures for optimal results. In 41%, an improvement of the symptoms was observed. Gait disorder was improved most often after valve-pressure adjustments (32%). 18 times an elevation of valve-pressure was necessary because of headaches, vertigo, or the development of subdural hygroma. Optimal valve-pressure for most patients was around 50 mmH2O (36%).

Conclusion: The goal of shunt therapy in iNPH should usually be valve-pressure settings between 30 and 70 mmH2O. Reactive adjustments of the valve-pressure are useful for therapy of over- and underdrainage symptoms. Planned reductions of the valve opening pressure are effective even if postoperative results are already satisfactory.

No MeSH data available.


Related in: MedlinePlus

Clinical improvement and worsening of symptoms after valve-pressure adjustments. After 33% adjustments an improvement of gait, after 20% an improvement of cognitive abilities, after 19% a reduction of vertigo, after 15% fewer headaches, and after 13% an improvement of bladder control were seen. Gait disorder worsened most often after valve-pressure reduction (36%); cognitive decline (10%), vertigo and headaches (15%), and urinary incontinence (24%) showed an aggravation less often
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Figure 2: Clinical improvement and worsening of symptoms after valve-pressure adjustments. After 33% adjustments an improvement of gait, after 20% an improvement of cognitive abilities, after 19% a reduction of vertigo, after 15% fewer headaches, and after 13% an improvement of bladder control were seen. Gait disorder worsened most often after valve-pressure reduction (36%); cognitive decline (10%), vertigo and headaches (15%), and urinary incontinence (24%) showed an aggravation less often

Mentions: A clinical improvement according to Kiefer-Scale was seen after 41% of valve-pressure adjustments. Gait disturbance (33%), cognitive disorder (20%), vertigo (19%), headaches (15%), and urinary incontinence (13%) responded to the reduction of valve-pressure. A reduction of ventricle size (Evans-Index) was verified after only three (1.7%) of valve-pressure adjustments [Figure 2].


Indications for valve-pressure adjustments of gravitational assisted valves in patients with idiopathic normal pressure hydrocephalus.

Gölz L, Lemcke J, Meier U - Surg Neurol Int (2013)

Clinical improvement and worsening of symptoms after valve-pressure adjustments. After 33% adjustments an improvement of gait, after 20% an improvement of cognitive abilities, after 19% a reduction of vertigo, after 15% fewer headaches, and after 13% an improvement of bladder control were seen. Gait disorder worsened most often after valve-pressure reduction (36%); cognitive decline (10%), vertigo and headaches (15%), and urinary incontinence (24%) showed an aggravation less often
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814988&req=5

Figure 2: Clinical improvement and worsening of symptoms after valve-pressure adjustments. After 33% adjustments an improvement of gait, after 20% an improvement of cognitive abilities, after 19% a reduction of vertigo, after 15% fewer headaches, and after 13% an improvement of bladder control were seen. Gait disorder worsened most often after valve-pressure reduction (36%); cognitive decline (10%), vertigo and headaches (15%), and urinary incontinence (24%) showed an aggravation less often
Mentions: A clinical improvement according to Kiefer-Scale was seen after 41% of valve-pressure adjustments. Gait disturbance (33%), cognitive disorder (20%), vertigo (19%), headaches (15%), and urinary incontinence (13%) responded to the reduction of valve-pressure. A reduction of ventricle size (Evans-Index) was verified after only three (1.7%) of valve-pressure adjustments [Figure 2].

Bottom Line: A total of 52 patients were provided with a Medos-Hakim valve(Codman®) with a Miethke shunt-assistant(Aesculap®) and 111 patients with a Miethke-proGAV(Aesculap®). 180 reductions of the valve-pressure took place (65% reactive, 35% planned).Optimal valve-pressure for most patients was around 50 mmH2O (36%).Planned reductions of the valve opening pressure are effective even if postoperative results are already satisfactory.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12686, Berlin, Germany.

ABSTRACT

Background: Modern ventriculoperitoneal shunts (VPS) are programmable, which enables clinicians to adjust valve-pressure according to their patients' individual needs. The aim of this retrospective analysis is to evaluate indications for valve-pressure adjustments in idiopathic normal pressure hydrocephalus (iNPH).

Methods: Patients operated between 2004 and 2011 diagnosed with iNPH were included. Kiefer-Scale was used to classify each patient. Follow-up exams were conducted 3, 6, and 12 months after shunt implantation and yearly thereafter. Initial valve-pressure was 100 or 70 mmH2O. Planned reductions of the valve-pressure to 70 and 50 mmH2O, respectively, were carried out and reactive adjustment of the valve-pressure to avoid over- and under-drainage were indicated.

Results: A total of 52 patients were provided with a Medos-Hakim valve(Codman®) with a Miethke shunt-assistant(Aesculap®) and 111 patients with a Miethke-proGAV(Aesculap®). 180 reductions of the valve-pressure took place (65% reactive, 35% planned). Most patients (89%) needed one or two adjustments of their valve-pressures for optimal results. In 41%, an improvement of the symptoms was observed. Gait disorder was improved most often after valve-pressure adjustments (32%). 18 times an elevation of valve-pressure was necessary because of headaches, vertigo, or the development of subdural hygroma. Optimal valve-pressure for most patients was around 50 mmH2O (36%).

Conclusion: The goal of shunt therapy in iNPH should usually be valve-pressure settings between 30 and 70 mmH2O. Reactive adjustments of the valve-pressure are useful for therapy of over- and underdrainage symptoms. Planned reductions of the valve opening pressure are effective even if postoperative results are already satisfactory.

No MeSH data available.


Related in: MedlinePlus