Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus

Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA.
Journal of Clinical Neuroscience (Impact Factor: 1.32). 06/2012; 19(8):1107-11. DOI: 10.1016/j.jocn.2011.11.019
Source: PubMed

ABSTRACT Ventriculoperitoneal shunt placement is the standard of care for idiopathic normal pressure hydrocephalus (iNPH). Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. Here we reviewed our experience with LP-HVV shunt placement for iNPH. We retrospectively reviewed our 33 patients with LP-HVV shunts inserted for the treatment of iNPH from 1998 to 2009. Patients were evaluated for improvements in gait, urinary function, and dementia after shunt placement. All patients had evidence of ventriculomegaly and a positive response to pre-operative lumbar puncture or extended lumbar drainage. All 33 (100%) patients had pre-operative gait dysfunction, 28 (85%) had incontinence, and 20 (61%) had memory deficits. Mean follow-up time was 19 months. Following shunt placement, 33/33 (100%) patients demonstrated improved gait, 13/28 (46%) had improvement in incontinence, and 11/20 (55%) had improvement in memory. Shunt failures requiring revision occurred in nine patients (27%), with an average time to failure of 11 months. Infections occurred in two patients (6%). There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage.

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    ABSTRACT: Idiopathic normal pressure hydrocephalus (iNPH) is currently treated mainly with lumboperitoneal (LP) shunts in Japan. Our aim was to evaluate whether LP shunting using Strata NSC programmable valves was as effective as ventriculoperitoneal (VP) shunting in the treatment of patients with iNPH from the perspectives of safety and symptomatic improvement rate.
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    ABSTRACT: Cerebrospinal fluid (CSF) biomarkers, including soluble amyloid β-42 (Aβ-42) and phosphorylated-tau (P-tau), reflect core pathophysiological features of Alzheimer's disease (AD). AD is frequently a concomitant pathology in older patients with idiopathic normal-pressure hydrocephalus (iNPH), and somewhat similar altered CSF dynamics exist in both AD and iNPH. We therefore investigated relationships between lumbar CSF biomarkers Aβ-42 and P-tau and clinical parameters in iNPH patients, along with differences in these biomarkers between CSF tap test (CSFTT) responders and non-responders. Thirty-one iNPH patients (14 CSFTT responders and 17 CSFTT non-responders) were included in the final analysis. We found lower CSF Aβ-42 correlated with poor cognitive performance (r=0.687, p<0.001 for Korean Mini Mental State Examination; r=0.568, p=0.001 for Frontal Assessment Battery; r=-0.439, p=0.014 for iNPH grading scale [iNPHGS] cognitive score; r=-0.588, p=0.001 for Clinical Dementia Rating Scale), and lower CSF P-tau correlated with gait dysfunction (r=-0.624, p<0.001 for Timed Up and Go Test; r=-0.652, p<0.001 for 10meter walking test; r=-0.578, p=0.001 for Gait Status Scale; r=-0.543, p=0.002 for iNPHGS gait score). In subgroup analysis, CSF P-tau/Aβ-42 ratios were significantly higher in CSFTT non-responders compared to responders (p=0.027). Two conjectures are suggested. One, CSF biomarkers may play different and characteristic roles in relation to different iNPH symptoms such as cognition and gait. Two, comorbid AD pathology in iNPH patients may affect the response to the CSFTT. Larger studies using combinations of other biomarkers associated with AD would be necessary to evaluate these hypotheses.
    Journal of Clinical Neuroscience 05/2014; 21(8). DOI:10.1016/j.jocn.2013.11.039 · 1.32 Impact Factor
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    ABSTRACT: Background Normal Pressure Hydrocephalus is a disease, which results from excess cerebral spinal fluid, it is often misdiagnosed for other degenerative diseases. Symptoms of Normal Pressure Hydrocephalus may be reversed with new treatment techniques such as shunting.AimsThe aim of this article is to review the pathophysiology of Normal Pressure Hydrocephalus, discuss how to distinguish it from other diseases and discuss treatment options, which show potential for treating Normal Pressure Hydrocephalus.Methods PubMed was used to conduct searches regarding the subject matter of this article.ResultsGait, dementia and urinary incontinence, which are also referred to as Adam's Triad, are typical associated with Normal Pressure Hydrocephalus. The pathophysiology of these conditions has been outlined in this article. Review articles have been outlined which discuss the potential certain shunt operations have to treat Normal Pressure Hydrocephalus.DiscussionThere are several known treatment options that have been successful when treating Normal Pressure Hydrocephalus. With the use of shunts to drain excess cerebral spinal fluid, it is possible to improve the patient's symptoms and thus improve their quality of life.Conclusion Normal Pressure Hydrocephalus should be considered when treating elderly patients that show signs of Adam's Triad. There are numerous types of treatment options available that show promise as to relieving some of the symptoms that are associated with Normal Pressure Hydrocephalus.
    08/2014; 2(6). DOI:10.1111/ncn3.117