Adjustable valves in normal-pressure hydrocephalus: A retrospective study of 218 patients

OBJECTIVE: We sought to assess the value of adjusting shunt valve opening pressure complications, and outcomes with the use of an adjustable shunt valve in the treatment,of patients with normal-pressure hydrocephalus (NPH). METHODS: In a single-center retrospective study, 231 adjustable valves, _(ra 200 mm H2O) were the first shunt, implantations in 147 patients with idiopathic NPH Jus men on gait (INPH) and 71 patients with secondary NPH (SNPH). The effect of adjustment on gait disturbance,, cognitive impairment, urinary incontinence and other symptoms Were evaluated, and an improvement index was created. RESULTS: In the INPH group, 138 adjustments were performed in 49.0% of-the patients, (average, 0.94 adjustments/patient). For the SNPH group, 49 adjustments were performed in 32.4% of the patients (average, 0.69 adjustments/patient). The reasons for adjustment were overdrainage in 48 patients (25.7%), underdrainage in 98 patients (52.4%), subdural, hematoma in 37 patients (19.8%) and other reasons in 2 patients (2.1%). Clinical status improved after 56 (49.1%) of all 114 adjustments, whereas 23 (42.6%) of 54 minor (less than or equal to20 mm H2O) and 33 (66.0%) of 50 larger adjustments improved the patient's clinical status The correlation of the improvement index with the size of the individual adjustments was, not significant. Complications occurred in 43 (19.7%) of 218 patients, valve malfunction occurred in 3 patients (1.3%), infection occurred in 14 patients (6.4%), subdural effusion occurred in 15 patients (6.9%; 8 were treated by adjustment,alone). The 5-year shunt survival rate was 80.2%. Outcomes-were excellent or good in 71 (78.9%) of 90 patients with INPH and in 30 (69.8%) of 43 patients with SNPH CONCLUSION: Noninvasive, particularly consecutive, minor or single larger adjustments patients ments to the valve opening pressure can further improve outcome in patients with NPH who undergo, shunting.