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Flow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome

  • Christian Wetzel
  • Lukas GoertzEmail author
  • Philipp Noé
  • Niklas von Spreckelsen
  • Marina Penner
  • Christoph Kabbasch
  • Roland Goldbrunner
  • Boris Krischek
Original Article - CSF Circulation
Part of the following topical collections:
  1. CSF Circulation

Abstract

Background

To compare flow-regulated (FR) and differential pressure (DP) valves for treatment of patients with idiopathic normal hydrocephalus (iNPH) focusing on overdrainage and neurological outcome.

Methods

This is a retrospective study of patients with iNPH treated with FR and DP valves at a single institution between 2008 and 2018. The neurological status was evaluated retrospectively with the Kiefer scale at baseline, after shunt placement and at the 6-month follow-up. Groups were compared using inverse probability of treatment weighting based on propensity scores.

Results

The study cohort consisted of 38 patients treated with FR valves and 49 with DP valves. The mean patient age was 72.0 ± 7.6 years. Based on the Kiefer scale score, neurological improvement at the 6-month follow-up was recorded in 79.6% in the DP group and 89.5% in the FR group (p = 0.252). The overdrainage rates were higher among DP valves (10.2%) than among FR valves (2.6%, adjusted p = 0.002). Valve malfunction occurred in 2.0% in the DP group and 5.3% in the FR group (adjusted p = 0.667).

Conclusions

The current study demonstrates a comparable neurological improvement between DP and FR valves, with potentially lower overdrainage rates among FR valves. Long-term studies will be necessary to draw a definite conclusion on FR valves for treatment of iNPH patients.

Keywords

Differential pressure valve Flow-regulated valve iNPH Normal pressure hydrocephalus Overdrainage 

Notes

Funding information

This study was supported by a grant provided by Integra® LifeSciences (Integra LifeSciences Services, Lyon, France).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclaimer

The sponsor had no role in the design or conduct of this research.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine and University Hospital, Center for NeurosurgeryUniversity of CologneCologneGermany
  2. 2.Department of NeurosurgeryBundeswehrkrankenhaus KoblenzKoblenzGermany
  3. 3.Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Department of NeuroradiologyUniversity Hospital of CologneCologneGermany

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