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Ultra-low pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable anti-gravity valves

Funnell, JP; D'Antona, L; Craven, C; Thorne, L; Watkins, L; Toma, A; (2020) Ultra-low pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable anti-gravity valves. Acta Neurochirurgica , 162 pp. 2967-2974. 10.1007/s00701-020-04596-z. Green open access

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Abstract

Background: Idiopathic normal-pressure hydrocephalus (NPH) is a condition of the elderly treated by ventriculoperitoneal shunt (VP) insertion. A subset of NPH patients respond only temporarily to shunt insertion despite low valve opening pressure. This study aims to describe our experience of patients who benefit from further CSF drainage by adding adjustable antigravity valves and draining CSF at ultra-low pressure. Methods: Single-centre retrospective case series of patients undergoing shunt valve revision from an adjustable differential pressure valve with fixed antigravity unit to a system incorporating an adjustable gravitational valve (Miethke proSA). Patients were screened from a database of NPH patients undergoing CSF diversion over 10 consecutive years (April 2008–April 2018). Clinical records were retrospectively reviewed for interventions and clinical outcomes. Results Nineteen (10F:9M) patients underwent elective VP shunt revision to a system incorporating an adjustable gravitational valve. Mean age 77.1 ± 7.1 years (mean ± SD). Eleven patients (58%) showed significant improvement in walking speed following shunt revision. Fourteen patients/carers (74%) reported subjective improvements in symptoms following shunt revision. Conclusions: Patients presenting symptoms relapse following VP shunting may represent a group of patients with ultra-low-pressure hydrocephalus, for whom further CSF drainage may lead to an improvement in symptoms. These cases may benefit from shunt revision with an adjustable gravitational valve, adjustment of which can lead to controlled siphoning of CSF and drain CSF despite ultra-low CSF pressure.

Type: Article
Title: Ultra-low pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable anti-gravity valves
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00701-020-04596-z
Publisher version: https://doi.org/10.1007/s00701-020-04596-z
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cerebrospinal fluid, Gravitational valve, Low-pressure hydrocephalus, Normal-pressure hydrocephalus, Shunt revision, Ventriculoperitoneal shunt
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/10109567
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