Abstract
Background: Controversies remain regarding the proper diagnostic studies and prediction of outcome in patients with normal pressure hydrocephalus (NPH), and their management remains controversial. We propose a preoperative assessment routine the aim of which is to correctly select NPH patients, and to differentiate between them in terms of surgical treatment, identifying probable endoscopic third ventriculostomy (ETV) responders.
Materials and methods: We prospectively considered a group of 44 patients with suspected NPH on the basis of clinical symptoms and neuroradiological evidence, who have undergone supplemental diagnostic testing (tap test, external lumbar drainage, cerebrospinal fluid outflow resistance [Rout] determination through lumbar and ventricular infusion test). All 44 of these patients were treated with either shunt procedures or ETV.
Results: To choose the kind of treatment (shunt or ETV), we evaluated the individual response during infusion tests. The efficacy of both surgical techniques was approximately 70%, with a significantly lower complication rate for ETV.
Conclusions: We evaluated the correlation between the various tests and the postoperative outcomes both for shunting and for ETV. Rout proved useful for preoperative assessment and choice of treatment. In carefully selected patients, ETV had qualitative results similar to shunting, presenting significantly fewer complications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure: a treatable syndrome. N Engl J Med 273:117–126
Black PM (1980) Idiopathic normal-pressure hydrocephalus: results of shunting in 62 patients. J Neurosurg 52:371–377
Gangemi M, Maiuri F, Buonamassa S, Colella G, de Divitiis E (2004) Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Neurosurgery 55:129–134
Gangemi M, Maiuri F, Naddeo M, Godano U, Mascari C, Broggi G, Ferroli P (2008) Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study. Neurosurgery 63(1):62–7; discussion 67–9
Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27:145–165
Greitz D (2007) Paradigm shift in hydrocephalus research in legacy of Dandy’s pioneering work: rationale for third ventriculostomy in communicating hydrocephalus. Childs Nerv Syst 23(5):487–9
Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z (2008) Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. J Neurosurg 109(5):923–30
Hakim S (1964) Some observations on CSF pressure: hydrocephalic syndrome in adults with “normal” CSF pressure. Javeriana University School of Medicine, Bogata (Thesis no. 957)
Hauser SL, Dawson DM, Lehrich JR et al (1983) Intensive immunosuppression in progressive multiple sclerosis: a randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. N Engl J Med 308:173–180
Katzman R, Hussey F (1970) A simple constant-infusion manometric test for measurement of CSF absorption: part I—rationale and method. Neurology 20:534–544
Marmarou A, Bergsneider M, Relkin N, Klinge P, Black PM (2005) Development of guidelines for idiopathic normal-pressure hydrocephalus: introduction. Neurosurgery 57(3 Suppl):S1–3; discussion ii-v
Meier U, Zeilinger FS, Schönher B (2000) Endoscopic ventriculostomy versus shunt operation in normal pressure hydrocephalus: diagnosis and indication. Acta Neurochir Suppl 76:563–566
Meier U, Zeilinger FS, Schönher B (2000) Endoscopic ventriculostomy versus shunt operation in normal pressure hydrocephalus: diagnosis and indication. Minim Invasive Neurosurg 43:87–90
Mitchell P, Mathew B (1999) Third ventriculostomy in normal pressure hydrocephalus. Br J Neurosurg 13:382–385
Rovner BW, Folstein MF (1987) Mini-mental state exam in clinical practice. Hosp Pract (Off Ed) 22(1A):99, 103, 106, 110
Trantakis C, Helm J, Keller M, Dietrich J, Meixensberger J (2004) Third ventriculostomy in communicating hydrocephalus in adult patients — the role of lumbar and cranial cerebrospinal fluid outflow measurement. Minim Invasive Neurosurg 47:140–144
Conflicts of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag/Wien
About this paper
Cite this paper
Paidakakos, N., Borgarello, S., Naddeo, M. (2012). Indications for Endoscopic Third Ventriculostomy in Normal Pressure Hydrocephalus. In: Aygok, G., Rekate, H. (eds) Hydrocephalus. Acta Neurochirurgica Supplementum, vol 113. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0923-6_25
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0923-6_25
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-0922-9
Online ISBN: 978-3-7091-0923-6
eBook Packages: MedicineMedicine (R0)