Safety, Effectiveness and Shunt Scale Guidelines for Ventriculo-Peritoneal Shunt Surgery with Programmable Valve in Elderly Normal Pressure Hydrocephalus Patients

Kim, Jong Gil; Lee, Ja Myoung; Chun, Dong Hyun; Lee, Young Seok; Lee, Kwang Ho; Kang, Dong Ho; Lee, Chul Hee; Jung, Jin-Myung; Han, Jong Woo; Park, In Sung

Clinical Article

Journal of Korean Society of Geriatric Neurosurgery 2019;15(2):70-77.
Published online September 30, 2019.

Safety, Effectiveness and Shunt Scale Guidelines for Ventriculo-Peritoneal Shunt Surgery with Programmable Valve in Elderly Normal Pressure Hydrocephalus Patients

Jong Gil Kim¹, Ja Myoung Lee¹, Dong Hyun Chun¹, Young Seok Lee¹, Kwang Ho Lee¹, Dong Ho Kang¹, Chul Hee Lee¹, Jin-Myung Jung¹, Jong Woo Han¹, In Sung Park^1,2

¹Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
²Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Abstract

Objective
The ventriculo-peritoneal shunt(VPS) surgery is a standard procedure for normal pressure hydrocephalus treat- ment. However, information about the clinical course and management of NPH in elderly patients is limited. This study analyzed datas to ensure that the VPS surgery with programmable valve is a safe and effective treatment in NPH patients aged ≥65 years, and to suggest adjustment of the shunt scale during VPS surgery.
Methods
The medical records of 89 patients(≥65 years) undergoing VPS surgery using programmable valve, between January 2009 and December 2017, were retrospectively reviewed. The patients were divided into iNPH and secondary NPH groups, and clinical and imaging features, VPS setting pressure, postoperative complications, shunt scale adjustment, outcomes of both groups were analyzed.
Results
Of the 89 patients, 17(19.10%) were diagnosed with iNPH, while remaining were in the secondary NPH group. The overall complication rate was 8.99%(8/89). And the shunt scale was adjusted in 15(88.23%) and 52(72.22%) patients of the iNPH and secondary NPH groups, respectively. And the clinical symptoms improved postoperatively in both groups during discharge and OPD follow-up. Also during the last OPD follow-up, the setting pressure was ~12cmH₂O in both groups.
Conclusion
The VPS with programmable valve is a safe and effective procedure in elderly NPH patients, regardless of the iNPH or secondary NPH status. Furthermore, adjusting the shunt scale to 12cmH₂O during VPS surgery could eliminate the hassle of multiple adjustments.

Key Words: Normal pressure hydrocephalus, Cerebrospinal fluid shunt, Programmable valve, Setting pressure