Department of Neurosciences, Unit of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
Department of Neurosciences, Academic Neurosurgery, University of Padova, Padova, Italy.
Oper Neurosurg (Hagerstown). 2019 Jul 1;17(1):97-102. doi: 10.1093/ons/opy232.
Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking.
To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study.
Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed.
Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries.
The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.
脑室-腹腔分流术（VP 分流术）是特发性正常压力脑积水（iNPH）的标准治疗方法。然而，对于该人群中 VP 分流术并发症的全面研究仍存在不足。
在欧洲多中心（EU-iNPH）研究中，报告 iNPH 患者在分流术后 1 年内逐渐发生的并发症分析和发生率。
通过 13 家机构前瞻性纳入 142 例患者进入 EU-iNPH 研究。所有患者均接受了可编程 VP 分流术。105 例患者完成了 12 个月的随访。术后 1、3 和 12 个月进行复查。收集并分析与分流过度或不足、感染、位置不当、硬膜下积液和分流手术相关的数据。
30 例患者（26%）出现分流过度症状。10 例（9%）报告有分流过度症状。43 例（37%）进行了分流调整。8 例（7%）发现分流位置不当是分流功能障碍的主要原因，仅 1 例（0.9%）发生感染。7 例（6%）诊断为硬膜下血肿，其中 5 例通过增加阀门的开启压力进行治疗。10 例（9%）诊断为皮下水肿，其中 1 例需要手术治疗。总体而言，17 例患者（15%）进行了 19 次分流手术。
阀门技术的进步、仔细的开启压力设置和严格的随访可以显著降低并发症的发生率，这些并发症通常可以在术后 3 至 6 个月内通过非手术方法得到控制。
