Free Article: Ventriculostomy or Shunt for Hydrocephalus

Background: Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation.

Objective: To compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS.

Methods: Randomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus.

Ahead of Print: Strategy for Adjusting Programmable Valves

Background: Management of overdrainage complications in shunted patients with idiopathic normal pressure hydrocephalus (INPH) remains a difficult task despite the use of programmable pressure valves (PPVs).

Objective: To assess the usefulness of a quick reference table (QRT) algorithm for achieving a suitable initial PPV setting in INPH patients who participated in the study for INPH on neurological improvement (SINPHONI).

Methods: One hundred registered patients diagnosed with probable INPH were treated with ventriculo-peritoneal shunts (VPS) using Codman-Hakim programmable valves (CHPV). In this series, the initial CHPV setting was decided prospectively according to the QRT algorithm. Shunt effectiveness, complications, and the number of CHPV readjustments during follow-up periods were investigated.