Optimized surgical treatment for normal pressure XXXX : comparison between gravitational and differential pressure valves.

@entity1 @entity3609 @entity322 @entity1276 @entity303 @entity73 @entity426
OBJECTIVES: In idiopathic normal pressure @entity1276 (NPH) ventriculoperitoneal (VP) shunt insertion is the method of choice to improve cardinal symptoms such as gait disturbance, urge @entity322 and/or @entity303 . With reduced compliance, the brain of the elderly is prone for overdrainage complications. This was especially true with the use of differential pressure valve implantation. The present study compares clinical outcome and complication rates after VP shunt insertion with differential pressure valves in the early years and gravitational valves since 2005. METHODS: The authors reviewed @entity1 treated at our institution for NPH since 1995. Differential pressure valves were solely used in the initial years, while the treatment regimen changed to gravitational valves in 2005. Clinical improvement/surgical success rates as well as complications were compared between the two groups. RESULTS: Eighty-nine @entity1 were enrolled for the present study. Mean age at the time of surgery was 73.5        6.3  years. Male @entity1 predominated with 73, compared with 16 female @entity1 . Median follow-up time was 28        26  months. Date of last follow-up was 1st October 2013. Forty-nine @entity1 received a gravitational valve, while 40 were treated with differential pressure valves. In the gravitational group a significant improvement was observed after shunt insertion for @entity426 , @entity73 and urge @entity322 (p   <   0.0001, resp. p   =   0.004), while a significant change in the differential pressure group was only seen for @entity426 (p   =   0.03) but not for cognition or urinary incontinency (p   >   0.05). The risk of @entity3609 as a sign of shunt overdrainage requiring surgical intervention was significantly higher in the differential pressure group (5 versus 0 in the gravitational group). CONCLUSIONS: @entity1 with NPH treated with gravitational valves in the present cohort showed a more profound improvement in their initial symptoms, including @entity426 , @entity73 and urinary incontinency without the risk of overdrainage complications requiring surgical intervention when compared with @entity1 who received differential pressure valves in previous years.
