[Shunt operation versus endoscopic ventriculostomy in normal pressure XXXX : diagnostics and outcome].

@entity1 @entity1276 @entity1887 @entity281 @entity9479 @entity340
In contrast to shunt operation the indication for an endoscopic ventriculostomy in @entity1 diagnosed for normal pressure @entity1276 is not scientifically established. From September 1997 to October 2001 we operated on 79 @entity1 diagnosed for normal pressure @entity1276 . Diagnosis was established by means of the intrathecal lumbal or ventricular infusion test, the cerebrospinal fluid tap test and MRI-CSF flow studies pre- and post-operatively. In 60 @entity1 (76 %) we implanted a ventriculo-peritoneal shunt (Miethke @entity340 ), and in 15 @entity1 (19 %) we performed the endoscopic assisted third ventriculostomy. With our created NPH recovery rate and use of the clinical grading for normal pressure @entity1276 created by Kiefer we compared the operative results of both @entity1 groups. Immediately after the operation the results are the same for both treatments. In the follow-up examination after 12 and 27 months @entity1 who underwent a ventriculostomy showed a better outcome, but the underdrainage rate was higher. Concerning the operation related complications the shunt treatment leaded to 10 revisions (17 %) because of four @entity281 (7 %), two @entity1887 (3 %), two overdrainages (3 %), two catheter dislocations (3 %). The ventriculostomy leaded to one case with a pneumatocephalus (7 %) and one @entity9479 (7 %). In both operation methods we saw cases of underdrainages, three after @entity340 (5 %) and two after ventriculostomy (13 %). In that @entity1 we performed a change of the implanted valve with a lower pressure level or rather an implantation of a valve system in the two cases who underwent a ventriculostomy. In @entity1 with a pathologically increased resistance to CSF outflow in the lumbal infusion test a shunt implantation with the Miethke @entity340 is indicated. @entity1 whose outflow resistance is increased in the ventricular infusion test are suspected for a functional interventricular stenosis and should be treated by means of an endoscopic assisted ventriculostomy.
