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Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus

  • Clinical Article
  • Published:
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Summary

Objectives. Normal-pressure hydrocephalus (NPH) syndrome is treatable by implantation of a cerebrospinal fluid (CSF) shunt. However, diagnosis of NPH by clinical and radiological findings alone is unreliable, and co-existing structural dementia can contribute to low success rates after shunt implantation. The aim of our study was to investigate whether long-term results after shunt implantation in NPH improve when surgical candidates are selected by continuous intraventricular pressure monitoring (CIPM).

Patients and methods. Ninety-two consecutive patients who were admitted with suspected NPH received CIPM for 48 h including an intraventricular steady-state infusion test to determine the resistance outflow. With positive CIPM, shunt implantation was performed and the patients were prospectively followed up for 1 to 10 years (median 6.5 years).

Results. CIPM was negative in 37 patients. Fifty-five patients had a positive CIPM and received CSF shunt. 96.1% of them improved from gait disturbance, 77.1% from cognitive impairment and 75.7% from urinary dysfunction. Clinical improvement remained during long-term follow-up in all but 3 patients who showed a decline at 4, 5 and 7 years, respectively. CIPM-related complications (ventriculitis) occurred in only one patient.

Conclusion. CIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.

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Abbreviations

CIPM:

Continuous intraventricular pressure monitoring

CSF:

cerebrospinal fluid

CT:

computed tomography

ICP:

intracranial pressure

INPH:

idiopathic/primary normal-pressure hydrocephalus syndrome

MRI:

magnetic resonance imaging

NPH:

normal-pressure hydrocephalus

PVI:

pressure volume index

SNPH:

symptomatic/secondary normal-pressure hydrocephalus syndrome

VFP:

ventricular fluid pressure

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Authors and Affiliations

  1. Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria

    W. K. Pfisterer, E. Gebhart, M. Aichholzer & M. Mühlbauer

  2. Department of Neurology, Donauspital SMZ-Ost, Vienna, Austria

    F. Aboul-Enein & M. Graf

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  1. W. K. Pfisterer
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  2. F. Aboul-Enein
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  3. E. Gebhart
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  4. M. Graf
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  5. M. Aichholzer
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  6. M. Mühlbauer
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Pfisterer, W., Aboul-Enein, F., Gebhart, E. et al. Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus. Acta Neurochir (Wien) 149, 983–990 (2007). https://doi.org/10.1007/s00701-007-1240-z

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