An Interdisciplinary Protocol for Ventriculoperitoneal Shunt Patient Selection in Normal Pressure Hydrocephalus.

Autor: McGrath K; College of Medicine, University of Florida, Gainesville, Florida, USA. Electronic address: kyle.mcgrath@neurosurgery.ufl.edu., Laurent D; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Otero O; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Hey G; College of Medicine, University of Florida, Gainesville, Florida, USA., Tomdio M; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Sorrentino Z; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Riklan J; College of Medicine, University of Florida, Gainesville, Florida, USA., Chowdhury MAB; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA., Isom E; UF Health- Heart Vascular and Neuromedicine Hospital, Gainesville, Florida, USA., Schreffler A; UF Health- Heart Vascular and Neuromedicine Hospital, Gainesville, Florida, USA., Musalo M; UF Health- Heart Vascular and Neuromedicine Hospital, Gainesville, Florida, USA., Rahman M; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Jul; Vol. 187, pp. e1-e11. Date of Electronic Publication: 2024 Apr 27.
DOI: 10.1016/j.wneu.2024.04.124
Abstrakt: Background: Normal pressure hydrocephalus can be treated with ventriculoperitoneal shunt (VPS) placement, but no broadly implemented indication for VPS exists.
Methods: Our protocol consists of physical therapy and occupational therapy practitioners administering validated tests of gait, balance, and cognition before and after lumbar drain placement. Specific tests include: Timed "Up & Go", Tinetti Gait and Balance Assessment, Berg Balance Scale, Mini Mental Status Exam, Trail Making Test Part B, and the Rey Auditory and Visual Learning Test. Minimal clinically important difference values for each test were determined from literature review. A retrospective review of patients treated under this protocol was performed. The primary outcomes were candidacy for VPS based on the protocol and patient-reported symptomatic improvement after VPS placement.
Results: A total of 48/75 (64%) patients received VPS. A total of 43/48 (89.6%) of those shunted reported improved symptoms at 6-week follow-up. However, 10/22 (45.5%) reported worsening symptoms at 1-year follow-up. The mean Tinetti score significantly increased after lumbar drain in patients who improved with VPS compared to the no shunt group (4.27 vs. -0.48, P < 0.001). A total of 6/33 (18%) patients with postoperative imaging had a subdural fluid collection identified and 3/49 (6%) had other complications, including 1 seizure, 1 intracerebral hemorrhage, and 1 stroke.
Conclusions: Standardized assessment of gait, balance, and cognition before and after temporary cerebrospinal fluid diversion identifies patients with normal pressure hydrocephalus likely to benefit from VPS placement with a low complication rate. One year after VPS, approximately one half of patients had symptoms recurrence.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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