Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
J Clin Neurosci. 2024 Jun;124:94-101. doi: 10.1016/j.jocn.2024.04.018. Epub 2024 Apr 27.
Overdrainage and frequent reprogramming are common problems with programmable valves after ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). Non-adjustable, flow-regulated valves offer a potential solution to these problems, but there is limited data on their efficacy. This study will evaluate neurological improvement and overdrainage rates within one year of treatment with a flow-regulated valve.
This prospective study analyzes 45 iNPH patients (median age: 73 years) treated with a flow-regulated valve. Clinical evaluations were performed at baseline, postoperatively, and at 3, 6, and 12 months after surgery. The primary efficacy endpoint was improvement of at least 5 points on the iNPH grading scale at follow-up. The safety endpoint was radiographic evidence of overdrainage.
All patients presented with gait disturbance, 35 (78 %) had cognitive impairment, and 35 (78 %) had urinary incontinence. The median duration of symptoms was 24 months. The total iNPH score improved in 33/41 (81 %) at 3 months, in 29/34 (85 %) at 6 months, and in 22/29 (64 %) at 12 months. Overall, 40/45 (89 %) patients had a significant improvement on the iNPH scale. Secondary worsening of symptoms after initial improvement was observed in 5 (11 %) patients. Overdrainage occurred in one patient (2 %) requiring surgical evacuation.
Treatment of iNPH patients with flow-regulated valves resulted in a good neurological outcome with minimal rates of overdrainage. These results are encouraging and justify the clinical use of these valve types.
特发性正常压力脑积水（iNPH）患者行脑室-腹腔分流术后，可编程分流阀常出现过度引流和频繁程控问题。不可调节、流量调节型分流阀可为这些问题提供潜在解决方案，但有关其疗效的数据有限。本研究将评估使用流量调节型分流阀治疗 1 年内的神经功能改善和过度引流发生率。
本前瞻性研究分析了 45 例接受流量调节型分流阀治疗的 iNPH 患者（中位年龄：73 岁）。临床评估在基线、术后及术后 3、6 和 12 个月进行。主要疗效终点为随访时 iNPH 分级量表至少改善 5 分。安全性终点为影像学证实过度引流。
所有患者均表现为步态障碍，35 例（78%）存在认知障碍，35 例（78%）存在尿失禁。症状持续时间中位数为 24 个月。3 个月时，41 例患者中有 33 例（81%）总 iNPH 评分改善，34 例中有 29 例（85%）在 6 个月时改善，29 例中有 22 例（64%）在 12 个月时改善。总体而言，45 例患者中有 40 例（89%）在 iNPH 量表上有显著改善。5 例（11%）患者在初始改善后出现症状的二次恶化。1 例（2%）患者出现过度引流，需行手术引流。
使用流量调节型分流阀治疗 iNPH 患者可获得良好的神经功能改善效果，且过度引流发生率低。这些结果令人鼓舞，证明了这些阀类型的临床应用价值。
