To Determine Outcome of Lumboperitoneal Shunt in Patients of Normal Pressure Hydrocephalus
Keywords:
Lumboperitoneal shunt, normal pressure hydrocephalus, outcomeAbstract
The patient presenting with gait disturbance, cognitive decline, or urinary incontinence represents a common cli-nical dilemma for the practicing neurologist and neurosurgeon. Although these symptoms are suggestive of normal pressure hydrocephalus (NPH), they are not specific to the diagnosis and commonly occur in neuro-degenerative conditions or nonspecifically in advanced age. A lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension and normal pressure hydrocephalus.
Objective: The objective of the study is to determine outcome of lumboperitoneal shunt in patients of normal pressure hydrocephalus.
Study Design: Case series study.
Place and Duration of Study: This study was conducted from December 19, 2012 to June 18, 2013 in the department of neurosurgery, Bahawal Victoria Hospital Bahawalpur.
Subject and Methods: 96 patients of normal pressure hydrocephalus, admitted in neurosurgery ward BVH Bahawalpur were included in the study. LP shunt procedure was done under general anesthesia. 3 weeks after operation complete clinical examination, urodynamic study and CT scan brain was done to see outcome of LP shunt.
Results: Total 96 patients were included in our study. The mean age of patients was 67.43 years with standard deviation of 5.395 years. Out of 96 patients, 47 (48.96%) were female and 49 (51.04%) patients were male. Out of 96 patients, 81 (84.38%) patients showed improved gait and 15 (15.62%) patients showed no improvement. Out of 96 patients, 49 patients showed improvement in incontinence while 47 patients showed no improvement. Out of 96 patients, 53 patients showed improvement in memory while 43 patients showed no improvement in memory.
Conclusion: Lumboperitoneal shunt placement is a safe and effective shunting for normal pressure hydro-cephalus, resulting in significant symptomatic improvement with a low risk of over-drainage.
References
2. Relkin N, Marmarou A, Klinge P, Bergsneider M, Bla-ck PM. Diagnosing idiopathic normal – pressure hydro-cephalus. Neurosurgery, 2005; 57: S4-16.
3. Nadkarni TD, Rekate HL, Wallace D. Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseu-dotumor cerebri: Review of 40 cases. J Neurosurg Pediatr. 2008; 2: 19-24.
4. Suri A, Pandey P, Mehta VS. Subarachnoid hemorrhage and intracerebral hematoma following lumboperitoneal shunt for pseudotumor cerebri: A rare complication. Neurology India, 2002; 50: 508-10.
5. Conn HO, Lobo FM. What do physicians know about normal pressure hydrocephalus and when did they know it? A survey of 284 physicians. Yale J Biol Med. 2008; 81 (1): 19-29.
6. Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: A retrospective study of 218 patients. Neurosurgery, 2002; 51: 1392–1400.
7. Takeuchi T, Kasahara E, Iwasaki M, Mima T, Mori K. Indications for shunting in patients with idiopathic nor-mal pressure hydrocephalus presenting with dementia and brain atrophy (atypical idiopathic normal pressure hydrocephalus). Neurol Med Chir (Tokyo), 2000; 40: 38–46.
8. Bloch O, McDermott MW. Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus. J Clin Neurosci. 2012; 19 (8): 1107-11.
9. McGirt MJ, Woodworth G, Coon AL, Thomas G, Wil-liams MA, Rigamonti D. Diagnosis, treatment, and ana-lysis of long-term outcomes in idiopathic normal-pres-sure hydrocephalus. Neurosurgery, 2005; 57 (4): 699-705.
10. Vanneste J, Augustijn P, Tan WF, Dirven C. Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry, 1993; 56: 251–6.
11. Ekstedt J. CSF hydrodynamic studies in man. 1. Method of constant pressure CSF infusion. J Neurol Neurosurg Psychiatry, 1977; 40: 105–119.
12. Klassen BT, Ahlskog JE. Normal pressure hydroce-phalus: how often does the diagnosis hold water? Neu-rology, 2011; 20; 77 (12): 1119-25.
13. Mori K. Management of idiopathic normal – pressure hydrocephalus: a multi-institutional study conducted in Japan. J Neurosurg. 2001; 95 (6): 970-3.
14. Pujari S, Kharkar S, Metellus P, Shuck J, Williams MA, Rigamonti D. Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry, 2008; 79 (11): 1282-6.
15. Hebb AO, Cusimano MD. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery, 2001; 49 (5): 1166-84.
16. Woodworth GF, McGirt MJ, Williams MA, Rigamonti D. Cerebrospinal fluid drainage and dynamics in the diagnosis of normal pressure hydrocephalus. Neurosur-gery, 2009; 64 (5): 919-25.
17. Savolainen S, Hurskainen H, Paljarvi L, Alafuzoff I, Vapalahti MP. Five-year outcome of normal pressure hydrocephalus with or without a shunt: Predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien). 2002; 144: 515–23.
18. Malm J, Kristensen B, Stegmayr B, Fagerlund M, Koskinen LO. Three – year survival and functional out-come of patients with idiopathic adult hydrocephalus syndrome. Neurology, 2000; 55: 576–8.
19. Børgesen SE, Gjerris F, Agerlin N. Shunting to the sagittal sinus. Acta Neurochir Suppl (Wien). 2002; 81: 11–4.
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