title: [Adult chronic idiopathic hydrocephalus-diagnosis, treatment and evolution. Prospective study].
abstract: BACKGROUND
  At present, chronic hydrocephalus or normal pressure hydrocephalus (NPH) has a controversial diagnosis in which multiple diagnostic and therapeutic techniques have been used with variable degrees of postoperative success. The aim of our study is to evaluate a number of patients diagnosed with adult chronic idiopathic hydrocephalus who were treated with a CSF shunt at our centre between 2006 and 2009 through clinical scales and radiological controls pre- and postoperatively.
  
  
  METHODS
  We prospectively analysed 40 patients. The diagnosis of idiopathic NPH was established when patients met 3 criteria: (i)clinical; (ii)radiological (Evans >0.3), and (iii)hydrodynamic (Katzman infusion test with Rout >12) or pathological ICP monitoring (B waves in over 20% of a nocturnal registration). We used a low-pressure DVP 5/35 GAV in all cases. Clinical assessments were conducted at 3, 6 and 12 months and radiological assessments at 6 months postoperatively. The clinical improvement of patients was assessed with the NPH, modified RANKIN and modified PFEIFFER rating scales.
  
  
  RESULTS
  The study of risk factors (age, gender, smoking, drinking, arterial hypertension, diabetes mellitus, dyslipidemia) did not establish statistically significant relationships. A statistically significant improvement was observed (P<.01) in the NPH and RANKIN tests at 3, 6 and 12 months. Clinical improvement values obtained were: NPH 73%, 74% and 64%, and RANKIN 54%, 72% and 56%, respectively. The PFEIFFER scale only showed a significant improvement at 12 months. These improvements were classified into various levels (high, moderate, mild and no improvement). The initial mean Evans index was 0.385, and 0.3675 postoperatively. There was only one infection of the valvular system (2%) without further complications. Morbidity and mortality related to the procedure were 0%.
  
  
  CONCLUSIONS
  An appropriate selection of patients through clinical, radiological, hydrodynamic and ICP monitoring criteria enables us to obtain good results and a low complication rate.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España. Electronic address: ncorderotous@gmail.com.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Cordero Tous
authors.forename: Ana María
authors.initials: AM
authors.lastname: Román Cutillas
authors.forename: Ana María
authors.initials: AM
authors.lastname: Jorques Infante
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Olivares Granados
authors.forename: Jose Enrique
authors.initials: JE
authors.lastname: Saura Rojas
authors.forename: Benjamín
authors.initials: B
authors.lastname: Iañez Velasco
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez Corral
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Roldán Serrano
authors.forename: Angel
authors.initials: A
authors.lastname: Horcajadas Almansa
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007427:Intracranial Pressure; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D000077325:Ringer's Lactate; D012720:Severity of Illness Index; D013129:Spinal Puncture; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate