オノ　シゲキ   Shigeki Ono   小野　成紀    所属   川崎医科大学  医学部 臨床医学　脳神経外科学２    職種   教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	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
掲載誌名	正式名：Neurosurgery ISSNコード：0148-396X
巻・号・頁	71(3),pp.722-8
著者・共著者	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
発行年月	2012/09
概要	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.