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In NPH, setting valve opening pressure close to lumbar puncture opening pressure decreases overdrainage
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Affiliations- Mayo Clinic, 4500 san pablo rd, 32224 Jacksonville, United States
- University of Texas
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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.
Keywords
NPH, shunting, lumbar puncture opening pressure, initial shunt valve setting, delta, overdrainage
About this articleTitle
In NPH, setting valve opening pressure close to lumbar puncture opening pressure decreases overdrainage
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
531-537
Published online
2020-10-12
Page views
1533
Article views/downloads
486
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2020;54(6):531-537.
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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