Affiliation:
1. Division of Clinical Neuroscience, Department of Neurosurgery, Rikshospitalet University Hospital, Oslo, Norway
Abstract
Abstract
OBJECTIVE
To review our experience of managing idiopathic normal pressure hydrocephalus (iNPH) during the 6-year period from 2002 to 2007, when intracranial pressure (ICP) monitoring was part of the diagnostic workup.
METHODS
The review includes all iNPH patients undergoing diagnostic ICP monitoring during the years 2002 to 2007. Clinical grading was done prospectively using a normal pressure hydrocephalus (NPH) grading scale (scores from 3 to 15). The selection of patients for surgery was based on clinical symptoms, enlarged cerebral ventricles, and findings on ICP monitoring. The median follow-up time was 2 years (range, 0.3–6 years). Both static ICP and pulsatile ICP were analyzed.
RESULTS
A total of 214 patients underwent the diagnostic workup, of whom 131 went on to surgery. Although 1 patient died shortly after treatment, 103 of the 130 patients (79%) improved clinically. This improvement lasted throughout the observation period. The static ICP observed during ICP monitoring was a poor predictor of the response to surgery. In contrast, among 109 of 130 patients with increased ICP pulsatility (ie, ICP wave amplitude >4 mm Hg on average and >5 mm Hg in >10% of recording time), 101 (93%) were responders (ie, increase in the NPH score of >2). Correspondingly, only 2 of 21 (10%) without increased ICP pulsatility were responders. Superficial wound infection was the only complication of ICP monitoring and occurred in 4 (2%) patients.
CONCLUSION
Surgical results in iNPH were good with almost 80% of patients improving after treatment. The data indicate that improvement after surgery can be anticipated in 9 of 10 iNPH patients with abnormal ICP pulsatility, but in only 1 of 10 with normal ICP pulsatility. Diagnostic ICP monitoring had a low complication rate.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Clinical Neurology,Surgery
Reference58 articles.
1. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome;Hebb;Neurosurgery.,2001
2. Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients;Marmarou;J Neurosurg.,2005
3. Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus;McGirt;Neurosurgery.,2005
4. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus;Marmarou;Neurosurgery.,2005
5. Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus;Pfisterer;Acta Neurochir (Wien).,2007
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