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

  • Original Article - CSF Circulation
  • Published:
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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.

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References

  1. Adams R, Fisher C, Hakim S, Ojemann R, Sweet W (1965) Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure: a treatable syndrome. N Engl J Med 273:117–126

    Article  CAS  Google Scholar 

  2. Bergsneider M, Black PM, Klinge P, Marmarou A, Relkin N (2005) Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S2-29-S22-39

    Article  Google Scholar 

  3. Bozhkov Y, Roessler K, Hore N, Buchfelder M, Brandner S (2017) Neurological outcome and frequency of overdrainage in normal pressure hydrocephalus directly correlates with implanted ventriculo-peritoneal shunt valve type. Neurol Res 39:601–605

    Article  Google Scholar 

  4. Capitanio JF, Venier A, Mazzeo LA, Barzaghi LR, Acerno S, Mortini P (2016) Prosepective study to evaluate rate and frequency of perturbations of implanted programmable Hakim Codman valve after 1.5-Tesla magnetic resonance imaging. World Neurosurg 88:297–299

    Article  Google Scholar 

  5. Carmel PW, Albright AL, Adelson PD, Canady A, Black P, Boydston W, Kneirim D, Kaufman B, Walker M, Luciano M (1999) Incidence and management of subdural hematoma/hygroma with variable-and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional valves. Neurosurg Focus 7:E8

    Article  Google Scholar 

  6. de Jong DA, Delwel EJ, Avezaat CJ (2000) Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochir 142:241–247

    Article  Google Scholar 

  7. Gehlen M, Eklund A, Kurtcuoglu V, Malm J, Daners MS (2017) Comparison of anti-siphon devices—how do they affect CSF dynamics in supine and upright posture? Acta Neurochir 159:1389–1397

    Article  Google Scholar 

  8. Gölz L, Lemcke J, Meier U (2013) Indications for valve-pressure adjustments of gravitational assisted valves in patients with idiopathic normal pressure hydrocephalus. Surg Neurol Int 4

    Article  Google Scholar 

  9. Kiefer M, Eymann R, Komenda Y, Steudel W (2003) Ein Graduierungssystem für den chronischen Hydrozephalus. Zentralbl Neurochir 64:109–115

    Article  CAS  Google Scholar 

  10. Kim KH, Yeo IS, Yi JS, Lee HJ, Yang JH, Lee IW (2009) A pressure adjustment protocol for programmable valves. J Korean Neurosurg Soc 46:370–377

    Article  Google Scholar 

  11. Klinge P, Hellstrom P, Tans J, Wikkelso C (2012) One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand 126:145–153

    Article  CAS  Google Scholar 

  12. Lemcke J, Meier U, Müller C, Fritsch MJ, Kehler U, Langer N, Kiefer M, Eymann R, Schuhmann MU, Speil A (2013) Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry 84:850–857

    Article  Google Scholar 

  13. Shaw R, Everingham E, Mahant N, Jacobson E, Owler B (2016) Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus. J Clin Neurosci 29:81–86

    Article  Google Scholar 

  14. Suchorska B, Kunz M, Schniepp R, Jahn K, Goetz C, Tonn J, Peraud A (2015) Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves. Acta Neurochir 157:703–709

    Article  CAS  Google Scholar 

  15. Sulter G, Steen C, De Keyser J (1999) Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30:1538–1541

    Article  CAS  Google Scholar 

  16. Wetzel C, Goertz L, Schulte AP, Goldbrunner R, Krischek B (2018) Minimizing overdrainage with flow-regulated valves - initial results of a prospective study on idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 173:31–37

    Article  Google Scholar 

Download references

Funding

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

Author information

Author notes

  1. Christian Wetzel and Lukas Goertz contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Christian Wetzel, Lukas Goertz, Philipp Noé, Niklas von Spreckelsen, Marina Penner, Roland Goldbrunner & Boris Krischek

  2. Department of Neurosurgery, Bundeswehrkrankenhaus Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany

    Philipp Noé

  3. Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Niklas von Spreckelsen

  4. Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Christoph Kabbasch

Authors
  1. Christian Wetzel
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  2. Lukas Goertz
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  3. Philipp Noé
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  4. Niklas von Spreckelsen
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  5. Marina Penner
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  6. Christoph Kabbasch
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  7. Roland Goldbrunner
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  8. Boris Krischek
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Corresponding author

Correspondence to Lukas Goertz.

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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.

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Comments

The authors report retrospectively on two cohorts of patients treated for idiopathic NPH in the same institution; 38 patients underwent insertion of VP shunts incorporating flow-regulated (FR) valves, and 49 patients with low pressure differential pressure (DP) valves. Although this was a non-randomised study, there was no difference in any of the measured baseline parameters between the two groups. Neurological change was reported using the Keifer scale at baseline and at 6 months. They also report on over drainage rates and shunt malfunction.

The authors conclude that there is no difference between neurological outcomes in the two groups; there is significantly less over drainage in the patients having the FR valves. The incidence of shunt malfunction was similar.

This is a clear paper with a succinct message. The use of FR valves in iNPH has not been investigated extensively, and I think this study provides a useful addition to the literature and encourages further investigation into the benefits of FR valves in iNPH.

Kristian Aquilina

London, UK

This is an interesting retrospective single-institution study comparing FR and DP valves for the treatment of iNPH. The paper is well-written, rigorously designed, and has meaningful conclusions. Though this topic has previously been discussed in the literature, this strong manuscript adds further evidence for readers.

Ali S. Haider

Chicago, USA

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This article is part of the Topical Collection on CSF Circulation

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Wetzel, C., Goertz, L., Noé, P. et al. Flow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome. Acta Neurochir 162, 15–21 (2020). https://doi.org/10.1007/s00701-019-04088-9

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  • DOI: https://doi.org/10.1007/s00701-019-04088-9

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