Advertisement

NPH: are we giving up on patients with temporary improvement post shunt?

  • Simon Thompson
  • Claudia Craven
  • Patricia Haylock-Vize
  • Edward Dyson
  • Aswin Chari
  • Samir Matloob
  • Neekhil Patel
  • Syed Shah
  • Andrew Stevens
  • Huan Wee Chan
  • Jinendra Ekanayake
  • Ahmed Toma
  • Lewis Thorne
  • Laurence Watkins
Open Access
Poster presentation
  • 323 Downloads

Keywords

Normal Pressure Hydrocephalus Shunt Infection Shunt Revision Normal Pressure Hydrocephalus Shunt Insertion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

Normal pressure Hydrocephalus (NPH) is predominantly treated with a ventriculoperitoneal shunt (VPS) resulting in improvement in the Hakim triad (mobility, cognitive function, urinary continence). There are a population of patients who experience an improvement in symptoms post shunt insertion followed by a subsequent deterioration in their condition in the proceeding months / years. At our institution, a large volume (min 40ml) CSF withdrawal is made via the shunt reservoir in these patients, measuring pre/post mobility and cognitive function. Comparison is then made between pre/post results and if a clear improvement is seen, VP shunt surgical revision is offered.

Methods

A single centre retrospective audit. Medical notes of temporarily improved NPH patients, admitted for a VPS Tap test and subsequent shunt revision at our institution over the past four years were reviewed. Walking test assessed over a 10m course at baseline, post initial shunt, pre Tap test, post tap test and post shunt revision were compared. Subjective feedback from patient / family also assessed.

Results

29 patients underwent tap tests via VPS shunt reservoir. No cases of shunt infection or sub-dural collections experienced post tap. 19 patients showed clinical improvement post Tap, 2 unable to withdraw CSF and subsequently underwent proximal catheter revision, 8 did not see improvement post tap and did not proceed with further neurosurgical treatment. Of the 19 positive results, 18 subsequently underwent shunt revision and 1 was lost to follow-up. All patients saw an improvement in symptoms post shunt revision including patients who had a proximal catheter blockage. 16 patients underwent insertion of Miethke Pro-SA valve post revision and 2 underwent insertion of Miethke Pro-GAV valve.

Conclusion

Taping of VP shunt in NPH patients with suspected blocked / under functioning shunt is a safe procedure and shows an accurate predictive value for improvement post surgery.

Copyright information

© Thompson et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Simon Thompson
    • 1
  • Claudia Craven
    • 1
  • Patricia Haylock-Vize
    • 1
  • Edward Dyson
    • 1
  • Aswin Chari
    • 1
  • Samir Matloob
    • 1
  • Neekhil Patel
    • 1
  • Syed Shah
    • 1
  • Andrew Stevens
    • 1
  • Huan Wee Chan
    • 1
  • Jinendra Ekanayake
    • 1
  • Ahmed Toma
    • 1
  • Lewis Thorne
    • 1
  • Laurence Watkins
    • 1
  1. 1.The National Hospital for Neurology and NeurosurgeryUK

Personalised recommendations