Discussion On Shunt Way And Selection Of Shunt Valve For Normal Pressure Hydrocephalus

Objective: Normal pressure hydrocephalus (NPH) is a type ofsyndrome that is associated with enlarged ventricle in the absence of raisedcerebrospinal fluid (CSF) pressure and is characterized by gait disorder,dementia and uroclepsia. Normal pressure hydrocephalus was put forward inthe clinical literature by Hakim and Adams for the first time in1965.Ventriculoperitoneal Shunt and Lumbar peritoneal Shunt are most adopted inthe treatment of normal pressure hydrocephalus, in which the medium or lowpressure shunt is usually selected. In this paper, we will discuss the choice forthe shunt way and pipe and the prediction of shunting effect of cerebrospinalfluid tap test through a retrospective study.Methods:67patients, diagnosed with normal pressure hydrocephalusand treated by Ventriculoperitoneal Shunt or Lumbar peritoneal shunt afterbeing hospitalized in The Second Hospital of Hebei Medical University fromAugust2004to August2013were collected. These cases included28(42%)patients with Idiopathic normal pressure hydrocephalus and39(58%) patientswith Secondary normal pressure hydrocephalus that consisted of14cases(36%) after traumatic brain injury,12cases (31%) after cerebral hemorrhage,and8cases (20%) after spontaneous subarachnoid hemorrhage,5cases (13%)after intracranial infection. Cerebrospinal fluid Tap tests were performed onall of the patients and the improvement of symptoms before and after tappingwas evaluated and recorded. Ventriculoperitoneal Shunt or Lumbar peritonealshunt was performed under general anesthesia according to situation andrequest of patient.32cases of58patients with Ventriculoperitoneal Shuntchose medium pressure shunt and the remaining26chose low pressure shunt.In comparison, all of the9patients with Lumbar peritoneal shunt chose lowpressure shunt. The improvement of symptoms was recorded during3months to1year’ follow up. SPSS13.0software was used, Count data using X2test.The results were statistically significant if P<0.05.Result:1After Ventriculoperitoneal Shunt or Lumbar peritoneal shunt，37in42patients of positive Tap test improved their clinical symptoms, with theefficiency of88%; by contrast,15out of25patients of negative Tap test hadtheir symptoms improved, with the efficiency of60%. Two groups of the totalefficiency had significant difference (P<0.05).221out of32patients in the group of Ventriculoperitoneal Shunt withmedium pressure shunt had a clinically improvement in symptoms aftersurgery, with success rate of66%;23in26patients in the group ofVentriculoperitoneal Shunt with low pressure shunt improved the symptoms,with the efficiency of88%; and8out of9patients in the group of Lumbarperitoneal Shunt with low pressure pipe grew better. That the sampling rate forthe three group were compared in pairs and x2-test for them were performedsuggested the following results: The effective rates of the two groups of V-PShunt with medium pressure shunt and V-P Shunt with low pressure shuntwere significantly different (P<0.005), the latter group was significantlyhigher than the former group; there was no statistically significant differencein efficiency between the group of VP with medium pressure shunt and theother two groups (P>0.05).3The number of arising complications in the group of V-P Shunt withmedium pressure pipe was6(19%), including4cases of blockage of shunt and2cases of subdural effusion.3(12%) patients in the group of V-P Shunt withlow pressure shunt had complications:1patient of blockage of shunt，1patientof infection and1of subdural effusion. The group of L-P Shunt with lowpressure shunt had no complication. That the incidences of complications ofthe three groups were compared in pairs and x2-test for them were donesuggested there was no statistically significant difference (P>0.05).Conclusions:1Tap test has good influence on increasing the shunt operation response of normal pressure hydrocephalus, especially idiopathic normal pressurehydrocephalus.2The low pressure shunt should be given high priority in the choice ofthe shunt for normal pressure hydrocephalus. Choosing adjustable shuntwhenever possible to achieve individualized regulating if condition permitsand the appropriate selection of the pressure of shunt greatly improves thesymptoms.3Compared with Ventriculoperitoneal Shunt, Lumbar peritoneal shunthas shorter operative time,less trauma, no damaging the brain, lower incidenceof complication such as epilepsy, impotency of the drainage tube, infection,and is worth of being generalized.