Shunt surgery in patients with hydrocephalus and white matter changes

Tisell, Magnus; Tullberg, Mats; Hellström, Per; Edsbagge, Mikael; Högfeldt, Mats; Wikkelsø, Carsten

doi:10.3171/2010.11.jns10967

Cited by 67 publications

(66 citation statements)

References 28 publications

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“…Exclusion criteria were: 1) a diagnosis of possible and unlikely INPH 10 ; 2) secondary hydrocephalus, as a consequence of head trauma, intracerebral hemorrhage, and meningitis/encephalitis; 3) serious clinical or laboratory contraindication for the procedure (blood dyscrasias not amenable to correction); 4) brain imaging findings associated with any of the following: ventricular dilatation caused by macroscopic obstruction to CSF flow, and evidence of severe cerebral atrophy (score 3) sufficient potentially to cause ventricular enlargement. Simple rating scales were used to quantify the degree of global cortical atrophy.…”

Section: Methodsmentioning

confidence: 99%

“…Identification of gait changes also enables the CSF-TT to differentiate NPH from other diseases that mimic it. Correct diagnosis avoids unnecessary surgical procedures, including complications that may occur in up to 50% of patients 10 . The aim of this study was to identify gait impairment and parameters that respond to the CSF-TT in patients with probable idiopathic NPH (INPH), according to diagnostic criteria in the American-European INPH guidelines 4 .…”

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confidence: 99%

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Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Souza

Rocha

Martins

et al. 2018

Arq. Neuro-Psiquiatr.

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Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy. Objectives: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait. Methods: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters. Results: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004). Conclusion: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Souza

Rocha

Martins

et al. 2018

Arq. Neuro-Psiquiatr.

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“…Adjustable valves were designed to lower the complication rate and optimize the effect of shunting. 26 After shunt surgery in iNPH patients, improvement rates between 61% and 90% have been reported, 6,[11][12][13][14]16,18,23 with recent studies revealing a rate above 80%. 13,24 The complication rates are high, up to 50%, 3,8,22 although a rate of 20% is evident in recent studies.…”

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confidence: 99%

“…8,26 The major complications are mechanical obstruction, infection, and subdural hematoma (SDH); the frequency of SDH is between 2% and 16%. 7,13,23 A Dutch NPH study recommended the use of a low A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or "fixed" pressure valve settings Object. This study was undertaken to investigate whether a gradual reduction of the valve setting (opening pressure) decreases the complication rate in patients with idiopathic normal-pressure hydrocephalus (iNPH) treated with a ventriculoperitoneal (VP) shunt.…”

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confidence: 99%

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

Sæhle

Farahmand

Eide

et al. 2014

JNS

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I dIopathIc normal pressure hydrocephalus (iNPH) is a treatable condition, first described by Hakim in 1965. 10 It is characterized clinically by gait disturbance, cognitive impairment, and urinary incontinence and radiologically by ventriculomegaly. The condition is typically diagnosed in the elderly and most often treated by insertion of a ventriculoperitoneal (VP) shunt with either a fixed or an adjustable pressure valve. Adjustable valves were designed to lower the complication rate and optimize the effect of shunting. 26 After shunt surgery in iNPH patients, improvement rates between 61% and 90% have been reported, 6,[11][12][13][14]16,18,23 with recent studies revealing a rate above 80%. 13,24 The complication rates are high, up to 50%, 3,8,22 although a rate of 20% is evident in recent studies. 8,26 The major complications are mechanical obstruction, infection, and subdural hematoma (SDH); the frequency of SDH is between 2% and 16%. 7,13,23 A Dutch NPH study recommended the use of a low A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or "fixed" pressure valve settings Object. This study was undertaken to investigate whether a gradual reduction of the valve setting (opening pressure) decreases the complication rate in patients with idiopathic normal-pressure hydrocephalus (iNPH) treated with a ventriculoperitoneal (VP) shunt.Methods. In this prospective double-blinded, randomized, controlled, dual-center study, a VP shunt with an adjustable valve was implanted in 68 patients with iNPH, randomized into two groups. In one group (the 20-4 group) the valve setting was initially set to 20 cm H 2 O and gradually reduced to 4 cm H 2 O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium pressure setting of 12 cm H 2 O during the whole study period. The time to and type of complications (hematoma, infection, and mechanical problems) as well as overdrainage symptoms were recorded. Symptoms, signs, and outcome were assessed by means of the iNPH scale and the NPH grading scale.Results. Six patients in the 20-4 group (22%) and 7 patients in the 12 group (23%) experienced a shunt complication; 9 had subdural hematomas, 3 mechanical obstructions, and 1 infection (no significant difference between groups). The frequency of overdrainage symptoms was significantly higher for a valve setting ≤ 12 cm H 2 O compared with a setting > 12 cm H 2 O. The 20-4 group had a higher improvement rate (88%) than the 12 group (62%) (p = 0.032). There was no significant relationship between complications and body mass index, the use of an antisiphon device, or the use of anticoagulants.Conclusions. Gradual lowering of the valve setting to a mean of 7 cm H 2 O led to the same rate of shunt complications and overdrainage symptoms as a fixed valve setting at a mean of 13 cm H 2 O but was associated with a significantly better outcome. (http://thejns.org/doi/abs/10.3171/2014.7.JNS14283) Key Wo...

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“…A common feature of human aging is enlarged lateral ventricles (ventriculomegaly) and associated periventricular edema as observed by MRI and fluid-attenuated inversion recovery MRI (MRI/FLAIR) [8][9][10][11][12][13][14] . To investigate the relationship between ventriculomegaly and the cellular organization of the ventricle lining, postmortem human MRI sequences were matched with histological preparations of lateral ventricle periventricular tissue.…”

Section: Introductionmentioning

confidence: 99%

3D Modeling of the Lateral Ventricles and Histological Characterization of Periventricular Tissue in Humans and Mouse

Acabchuk

Sun

Wolferz

et al. 2015

JoVE

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The ventricular system carries and circulates cerebral spinal fluid (CSF) and facilitates clearance of solutes and toxins from the brain. The functional units of the ventricles are ciliated epithelial cells termed ependymal cells, which line the ventricles and through ciliary action are capable of generating laminar flow of CSF at the ventricle surface. This monolayer of ependymal cells also provides barrier and filtration functions that promote exchange between brain interstitial fluids (ISF) and circulating CSF. Biochemical changes in the brain are thereby reflected in the composition of the CSF and destruction of the ependyma can disrupt the delicate balance of CSF and ISF exchange. In humans there is a strong correlation between lateral ventricle expansion and aging. Age-associated ventriculomegaly can occur even in the absence of dementia or obstruction of CSF flow. The exact cause and progression of ventriculomegaly is often unknown; however, enlarged ventricles can show regional and, often, extensive loss of ependymal cell coverage with ventricle surface astrogliosis and associated periventricular edema replacing the functional ependymal cell monolayer. Using MRI scans together with postmortem human brain tissue, we describe how to prepare, image and compile 3D renderings of lateral ventricle volumes, calculate lateral ventricle volumes, and characterize periventricular tissue through immunohistochemical analysis of en face lateral ventricle wall tissue preparations. Corresponding analyses of mouse brain tissue are also presented supporting the use of mouse models as a means to evaluate changes to the lateral ventricles and periventricular tissue found in human aging and disease. Together, these protocols allow investigations into the cause and effect of ventriculomegaly and highlight techniques to study ventricular system health and its important barrier and filtration functions within the brain. Video LinkThe video component of this article can be found at

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Shunt surgery in patients with hydrocephalus and white matter changes

Abstract: Patients with enlarged ventricles, hydrocephalic symptoms, and extensive vascular white matter changes benefit from shunt surgery.

Cited by 67 publications

References 28 publications

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

3D Modeling of the Lateral Ventricles and Histological Characterization of Periventricular Tissue in Humans and Mouse

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