Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus.
OBJECTIVE
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).


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.


CONCLUSIONS
CIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.
Pfisterer
W K
WK
Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria. wolfgang.pfisterer@wienkav.at
Aboul-Enein
F
F
Gebhart
E
E
Graf
M
M
Aichholzer
M
M
Mühlbauer
M
M
D002557:Cerebrospinal Fluid Shunts; D003704:Dementia / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000601:surgery; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D017725:Ventricular Pressure / Q000502:physiology*