Ahead of print
Research paper
Published online: 2020-10-12
Submitted: 2020-05-15
Accepted: 2020-08-25
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In NPH, setting valve opening pressure close to lumbar puncture opening pressure decreases overdrainage

Tito Vivas-Buitrago, Ricardo Domingo, Shashwat Tripathi, Juan Pablo Herrera, Johan Heemskerk, Sanjeet Grewal, Nicholas L. Zalewski, Alfredo Quinones-Hinojosa, Ronald Reimer, Robert E. Wharen, Neil R. Graff-Radford
DOI: 10.5603/PJNNS.a2020.0077
·
Pubmed: 33047786

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Ahead of print
Research paper
Published online: 2020-10-12
Submitted: 2020-05-15
Accepted: 2020-08-25

Abstract

Background. The management of normal pressure hydrocephalus (NPH) can be difficult, partly because there are frequent treatment complications such as overdrainage which, when serious, may require surgical intervention. We previously reported a correlation between the difference of lumbar puncture opening pressure minus the valve opening pressure setting (LPOP–VOP) (which we refer to as the delta) and increased rates of overdrainage. This led to a modification in our practice, whereby we now set the VOP equal to, or close to, the LPOP, resulting in lower deltas.

Objective. In this new study, our aim was to compare the rate of overdrainage in our patients with higher and lower deltas and assess the significance of setting the VOP equal, or close, to the patient’s LPOP.

Methods.
1. We reproduced the association between delta and overdrainage. 2. We compared the incidence of overdrainage in those whose VOP was set close to LPOP (low delta) versus those with VOP setting distant from the LPOP (higher delta). 3. We compared symptom improvement in those with a low versus higher delta.

Results.
We confirmed the relation between high delta and an increased rate of overdrainage, lower rates of overdrainage in those whose VOP was set close to the LPOP (Delta Adjusted Practice), and better improvement of symptoms when the VOP was set closer to the LPOP.

Conclusion.
We propose that the initial VOP should be set as close as possible to the patient’s LPOP to decrease overdrainage without compromising symptom improvement.

Abstract

Background. The management of normal pressure hydrocephalus (NPH) can be difficult, partly because there are frequent treatment complications such as overdrainage which, when serious, may require surgical intervention. We previously reported a correlation between the difference of lumbar puncture opening pressure minus the valve opening pressure setting (LPOP–VOP) (which we refer to as the delta) and increased rates of overdrainage. This led to a modification in our practice, whereby we now set the VOP equal to, or close to, the LPOP, resulting in lower deltas.

Objective. In this new study, our aim was to compare the rate of overdrainage in our patients with higher and lower deltas and assess the significance of setting the VOP equal, or close, to the patient’s LPOP.

Methods.
1. We reproduced the association between delta and overdrainage. 2. We compared the incidence of overdrainage in those whose VOP was set close to LPOP (low delta) versus those with VOP setting distant from the LPOP (higher delta). 3. We compared symptom improvement in those with a low versus higher delta.

Results.
We confirmed the relation between high delta and an increased rate of overdrainage, lower rates of overdrainage in those whose VOP was set close to the LPOP (Delta Adjusted Practice), and better improvement of symptoms when the VOP was set closer to the LPOP.

Conclusion.
We propose that the initial VOP should be set as close as possible to the patient’s LPOP to decrease overdrainage without compromising symptom improvement.

Get Citation

Keywords

NPH, shunting, lumbar puncture opening pressure, initial shunt valve setting, delta, overdrainage

About this article
Title

In NPH, setting valve opening pressure close to lumbar puncture opening pressure decreases overdrainage

Journal

Neurologia i Neurochirurgia Polska

Issue

Ahead of print

Published online

2020-10-12

DOI

10.5603/PJNNS.a2020.0077

Pubmed

33047786

Keywords

NPH
shunting
lumbar puncture opening pressure
initial shunt valve setting
delta
overdrainage

Authors

Tito Vivas-Buitrago
Ricardo Domingo
Shashwat Tripathi
Juan Pablo Herrera
Johan Heemskerk
Sanjeet Grewal
Nicholas L. Zalewski
Alfredo Quinones-Hinojosa
Ronald Reimer
Robert E. Wharen
Neil R. Graff-Radford

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