Acta Neurochirurgica

, Volume 149, Issue 10, pp 983–990

Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus

  • W. K. Pfisterer
  • F. Aboul-Enein
  • E. Gebhart
  • M. Graf
  • M. Aichholzer
  • M. Mühlbauer
Clinical Article

Summary

Objectives. Normal-pressure hydrocephalus (NPH) syndrome is treatable by implantation of a cerebrospinal fluid (CSF) shunt. However, diagnosis of NPH by clinical and radiological findings alone is unreliable, and co-existing structural dementia can contribute to low success rates after shunt implantation. The aim of our study was to investigate whether long-term results after shunt implantation in NPH improve when surgical candidates are selected by continuous intraventricular pressure monitoring (CIPM).

Patients and methods. Ninety-two consecutive patients who were admitted with suspected NPH received CIPM for 48 h including an intraventricular steady-state infusion test to determine the resistance outflow. With positive CIPM, shunt implantation was performed and the patients were prospectively followed up for 1 to 10 years (median 6.5 years).

Results. CIPM was negative in 37 patients. Fifty-five patients had a positive CIPM and received CSF shunt. 96.1% of them improved from gait disturbance, 77.1% from cognitive impairment and 75.7% from urinary dysfunction. Clinical improvement remained during long-term follow-up in all but 3 patients who showed a decline at 4, 5 and 7 years, respectively. CIPM-related complications (ventriculitis) occurred in only one patient.

Conclusion. CIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.

Keywords: Normal pressure hydrocephalus; continuous intraventricular pressure monitoring; intraventricular steady-state infusion; ventriculoatrial shunt. 

Abbreviations

CIPM

Continuous intraventricular pressure monitoring

CSF

cerebrospinal fluid

CT

computed tomography

ICP

intracranial pressure

INPH

idiopathic/primary normal-pressure hydrocephalus syndrome

MRI

magnetic resonance imaging

NPH

normal-pressure hydrocephalus

PVI

pressure volume index

SNPH

symptomatic/secondary normal-pressure hydrocephalus syndrome

VFP

ventricular fluid pressure

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • W. K. Pfisterer
    • 1
  • F. Aboul-Enein
    • 2
  • E. Gebhart
    • 1
  • M. Graf
    • 2
  • M. Aichholzer
    • 1
  • M. Mühlbauer
    • 1
  1. 1.Department of NeurosurgeryDonauspital SMZ-OstViennaAustria
  2. 2.Department of NeurologyDonauspital SMZ-OstViennaAustria

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