Shigeki Ono
Department Kawasaki Medical School Kawasaki Medical School, Department of Neurosurgery 2, Position Professor |
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Article types | 原著 |
Language | English |
Peer review | Peer reviewed |
Title | Assessment of a Quick Reference Table Algorithm for Determining Initial Postoperative Pressure Settings of Programmable Pressure Valves in Patients With Idiopathic Normal Pressure Hydrocephalus:SINPHONI Subanalysis |
Journal | Formal name:Neurosurgery ISSN code:0148-396X |
Volume, Issue, Page | 71(3),pp.722-8 |
Author and coauthor | Hiroji Miyake,MD,DMSc Yoshinaga Kajimoto,MD,DMSc
Hisayuki Murai,MD,DMSc Sadahiro Nomura,MD,MDSc Shigeki Ono,MD,DMSc Yuji Okamoto,MD,DMSc Yoshihiro Sumi,MD,DMSc |
Publication date | 2012/09 |
Summary | BACKGROUND:
Management of overdrainage complications in shunted patients with idiopathic normal pressure hydrocephalus (INPH) remains a difficult task despite the use of programmable pressure valves. OBJECTIVE: To assess the usefulness of a quick reference table (QRT) algorithm for achieving a suitable initial programmable pressure valve setting in INPH patients who participated in the Study for INPH on Neurological Improvement (SINPHONI). METHODS: One hundred registered patients diagnosed with probable INPH were treated with ventriculoperitoneal shunts using Codman-Hakim programmable valves (CHPVs). In this series, the initial CHPV setting was decided prospectively according to the QRT algorithm. Shunt effectiveness, complications, and the number of CHPV readjustments during follow-up periods were investigated. RESULTS: Eighty patients were considered better than shunt responders (more than 1 point improvement in modified Rankin scale at any follow-up period). Readjustments of CHPVs within 3 months after treatment with ventriculoperitoneal shunt were performed 56 times in 44 cases (44%, 0.56 times/patient). Low-pressure headache occurred in 9 patients, all of whom improved by readjustment alone. Nontraumatic subdural fluid collections and chronic subdural hematomas occurred in 15 cases (15%); however, most of the cases were subclinical and improved after CHPV readjustments alone. Burr hole irrigation was necessary in only 1 case. CONCLUSION: Use of the QRT algorithm was associated with a decrease in postoperative CHPV readjustments and serious overdrainage complications during the follow-up period. The QRT algorithm is an easy, safe, and effective method for determining the initial CHPV pressure setting in INPH patients. |