Surgical Treatment Of Normal Pressure Hydrocephalus

ObjectiveNormal pressure hydrocephalus (NPH) is a clinical and radiographic syndrome first described by Hakim and Adamsin 1965 and characterized clinically by gait impairment, dementia, and urinary incontinence. Only a minority of patients present with the complete triad of symptoms, gait impairment being the most common presenting complaint. On brain imaging, one sees ventricular enlargement without significant cerebral atrophy. Treatment with shunt surgery is most likely to increase mobility, and may also improve dementia and urinary symptoms. It has been reported that Cerebrospinal Fluid tap test ( CSF-tt) is a very accurate test for predicting the outcome after ventricular shunting in patients with normal pressure hydrocephalus. The main goal of this study is to explore nosogenesis, clinical manifestation, CT, MRI, operative indication, method, opportunity and predict the effect of shunt surgery through drainage of cerebrospinal fluid with lumbar puncture.Methods48 patients of normal pressure hydrocephalus from June 2002 to June 2008 were reviewed. All the patients were treated by ventriculo-peritoneal shunt. Clinical assessment were followed by lumbar puncture as removing 20 ml CSF. The correlation between the variation of symptoms with drainage of cerebrospinal fluid with lumbar puncture and shunt surgery was retrospectively analyzed. The effect of adjustment on gait disturbance, cognitive impairment, urinary incontinence and other symptoms were evaluated, and an improvement index was created.ResultBetween June 2002 to June 2008, 48 NPH patients included. 21 had idiopathic NPH, and the remaining 27 had secondary NPH. All the patients have been done clinical assessment which was followed by lumbar puncture as removing 20 ml CSF. All the patients were done the ventriculo-peritoneal shunt. 15 patients had adjustable shunt system, and the remaining 33 had nonadjustable shunt system. 3 months after surgery, 41 of the 48(85.4%) shunted patients had improved. Complications occurred in 10(20.1%) of 48 patients, valve malfunction occurred in 3patients (6.2%), infection occurred in 2 patients (4.2%), and nontraumatic subdural effusion occurred in 5 patients (10.4%).ConclusionsThe study suggests that Cerebrospinal Fluid tap test (CSF-tt) is a very accurate test for predicting the outcome after ventricular shunting in patients with normal pressure hydrocephalus. NPH is a reversible disorder characterized by gait impairment, dementia, and urinary incontinence associated with impaired cerebrospinal fluid circulation and ventriculomegaly. Given the correct diagnosis, shunt insertion can produce marked improvement in patients with NPH syndrome, causing few deaths and few clinically relevant complications.