caa a22 4500 606215697 CHVBK 20210128101100.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s00701-015-2345-4 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2345-4 Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves [Elektronische Daten] [B. Suchorska, M. Kunz, R. Schniepp, K. Jahn, C. Goetz, J. Tonn, A. Peraud] Objectives: In idiopathic normal pressure hydrocephalus (NPH) ventriculoperitoneal (VP) shunt insertion is the method of choice to improve cardinal symptoms such as gait disturbance, urge incontinence and/or dementia. 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 patients 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 patients were enrolled for the present study. Mean age at the time of surgery was 73.5 ± 6.3years. Male patients predominated with 73, compared with 16 female patients. Median follow-up time was 28 ± 26months. Date of last follow-up was 1st October 2013. Forty-nine patients 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 gait disorder, cognitive impairment and urge incontinence (p < 0.0001, resp. p = 0.004), while a significant change in the differential pressure group was only seen for gait disorder (p = 0.03) but not for cognition or urinary incontinency (p > 0.05). The risk of hygroma 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: Patients with NPH treated with gravitational valves in the present cohort showed a more profound improvement in their initial symptoms, including gait disorder, cognitive impairment and urinary incontinency without the risk of overdrainage complications requiring surgical intervention when compared with patients who received differential pressure valves in previous years. Springer-Verlag Wien, 2015 Normal pressure hydrocephalus nationallicence NPH nationallicence Gravitational valve nationallicence Differential pressure valve nationallicence Gait nationallicence Dementia nationallicence Incontinence nationallicence Outcome nationallicence Suchorska B. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Kunz M. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Schniepp R. Klinikum Großhadern, Neurologische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Jahn K. Klinikum Großhadern, Neurologische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Goetz C. Asklepios Klinik Nord Heidberg, Abteilung fürNeurochirurgie, Tangstedter Landstr. 400, 22417, Hamburg, Germany aut Tonn J. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Peraud A. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 703-709 0001-6268 157:4<703 2015 157 701 https://doi.org/10.1007/s00701-015-2345-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2345-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Suchorska B. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 700 1- Kunz M. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 700 1- Schniepp R. Klinikum Großhadern, Neurologische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 700 1- Jahn K. Klinikum Großhadern, Neurologische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 700 1- Goetz C. Asklepios Klinik Nord Heidberg, Abteilung fürNeurochirurgie, Tangstedter Landstr. 400, 22417, Hamburg, Germany aut NATIONALLICENCE 700 1- Tonn J. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 700 1- Peraud A. Klinikum Großhadern, Neurochirurgische Klinik und Poliklinik, Marchioninistrasse 15, 81377, München, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 703-709 0001-6268 157:4<703 2015 157 701