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Acta Neurochirurgica
Published in: Acta Neurochirurgica 4/2015

01-04-2015 | Clinical Article - Neurosurgical Techniques

Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves

Authors: B. Suchorska, M. Kunz, R. Schniepp, K. Jahn, C. Goetz, J. C. Tonn, A. Peraud

Published in: Acta Neurochirurgica | Issue 4/2015

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Abstract

Objectives

In idiopathic normal pressure hydrocephalus (NPH) ventriculoperitoneal (VP) shunt insertion is the method of choice to improve cardinal symptoms such as gait disturbance, urge incontinence and/or dementia. With reduced compliance, the brain of the elderly is prone for overdrainage complications. This was especially true with the use of differential pressure valve implantation. The present study compares clinical outcome and complication rates after VP shunt insertion with differential pressure valves in the early years and gravitational valves since 2005.

Methods

The authors reviewed patients treated at our institution for NPH since 1995. Differential pressure valves were solely used in the initial years, while the treatment regimen changed to gravitational valves in 2005. Clinical improvement/surgical success rates as well as complications were compared between the two groups.

Results

Eighty-nine patients were enrolled for the present study. Mean age at the time of surgery was 73.5 ± 6.3 years. Male patients predominated with 73, compared with 16 female patients. Median follow-up time was 28 ± 26 months. Date of last follow-up was 1st October 2013. Forty-nine patients received a gravitational valve, while 40 were treated with differential pressure valves. In the gravitational group a significant improvement was observed after shunt insertion for gait disorder, cognitive impairment and urge incontinence (p < 0.0001, resp. p = 0.004), while a significant change in the differential pressure group was only seen for gait disorder (p = 0.03) but not for cognition or urinary incontinency (p > 0.05). The risk of hygroma as a sign of shunt overdrainage requiring surgical intervention was significantly higher in the differential pressure group (5 versus 0 in the gravitational group).

Conclusions

Patients with NPH treated with gravitational valves in the present cohort showed a more profound improvement in their initial symptoms, including gait disorder, cognitive impairment and urinary incontinency without the risk of overdrainage complications requiring surgical intervention when compared with patients who received differential pressure valves in previous years.
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Metadata
Title
Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves
Authors
B. Suchorska
M. Kunz
R. Schniepp
K. Jahn
C. Goetz
J. C. Tonn
A. Peraud
Publication date
01-04-2015
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 4/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-015-2345-4

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