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Complications Related to the Type of Hydrocephalus: Normal Pressure Hydrocephalus

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Complications of CSF Shunting in Hydrocephalus

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Abstract

A clear trend towards better outcomes in patients with normal pressure hydrocephalus (NPH) has been shown in studies published in the last decade. This is due in part to the availability of more sophisticated hardware and a better understanding of the risks and characteristics of these fragile patients. Because there is no robust evidence showing the superiority of specific type of valve, neurosurgeons face a dilemma in choosing the most adequate shunt, an essential step in improving outcome and avoiding “shunt-patient mismatch.” The most commonly known consequence of hydrodynamic mismatch is shunt overdrainage. However, a lesser-known consequence of poor hardware selection is occult shunt dysfunction, which can cause lack of improvement or later deterioration after initial improvement. Shunt selection must be based on the fact that intracranial pressure (ICP) and CSF dynamics are highly heterogeneous in NPH. Patients may present active hydrocephalus (mean ICP >12 mmHg), compensated hydrocephalus (mean ICP of 5–12 mmHg), or even low-pressure hydrocephalus (ICP <5 mmHg). In addition to the valve, which has a specific opening pressure and resistance, the shunt system must include a gravitational device. Clinical symptoms and neuroimaging studies are sufficient to diagnose complications related with overdrainage. However, continuous ICP monitoring helps to identify possible cases of underdrainage that result in a lack of improvement in certain patients. In the management of patients with NPH, ICP values and intra-abdominal pressure, as well as the hydrodynamic proprieties of the shunt system selected, must be considered.

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Acknowledgments

We gratefully acknowledge Sabrina Voss for editorial assistance as well as the nurses of the Neurosurgery Department, especially María Jesus Peñarrubia and Maria Asunción Muns, for their collaboration in the studies performed. The authors of this chapter have no conflicts of interest with regard to the manufacturers or distributors of the devices mentioned in the text.

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Authors and Affiliations

  1. Department of Neurosurgery and Neurotraumatology Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    María Antonia Poca MD, PhD & Juan Sahuquillo MD, PhD

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  1. María Antonia Poca MD, PhD
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  2. Juan Sahuquillo MD, PhD
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Correspondence to María Antonia Poca MD, PhD .

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Editors and Affiliations

  1. Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy

    Concezio Di Rocco

  2. Department of Neurosurgery, Adnan Menderes University School of Medi, Aydin, Turkey

    Mehmet Turgut

  3. Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    George Jallo

  4. Regional Service of Neurosurgery and Unit of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Juan F. Martínez-Lage

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Poca, M.A., Sahuquillo, J. (2015). Complications Related to the Type of Hydrocephalus: Normal Pressure Hydrocephalus. In: Di Rocco, C., Turgut, M., Jallo, G., Martínez-Lage, J. (eds) Complications of CSF Shunting in Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-09961-3_11

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