ABSTRACT
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH. .
A hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatadas em outros estudos. Conclusões: A válvula Strata® utilizada no protocolo proposto representa uma ferramenta eficiente e segura no tratamento de iNPH. .
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cerebrospinal Fluid Shunts/instrumentation , Hydrocephalus, Normal Pressure/surgery , Cerebrospinal Fluid Shunts/adverse effects , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.
Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL); 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Cerebrospinal Fluid Shunts/instrumentation , Drainage/instrumentation , Hydrocephalus/surgery , Hydrostatic Pressure/adverse effects , Cerebrospinal Fluid Pressure/physiology , Cerebrospinal Fluid Shunts/adverse effects , Equipment Design , Hematoma, Subdural/etiology , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus, Normal Pressure/surgery , Hydrocephalus/physiopathology , Prospective Studies , Pseudotumor Cerebri/etiology , Slit Ventricle Syndrome/etiology , Tomography, X-Ray ComputedABSTRACT
Introduction: Ionizing radiation is the only established risk factor today in the pathogenesis of meningioma. Radiation-induced meningiomas (RIMs)are an unusual complication of radiation therapy which often challenge skilled neurosurgeons. We report 2 RIM cases and discuss existing reports. Case Reports: A 55-year old woman presented with a RIM after adjuvant radiation therapy for low-grade astrocytoma. An 18-year old man presented a RIM after craniospinal radiation therapy for medulloblastoma. Both patients were treated and are alive and well. Discussion: RIMs have been associated with younger age at symptom onset, higher male-to-female ratio and more aggressive meningiomas. Our reports have several common points with existing RIM series. Prolonged radiological surveillance for RIMs has been suggested, but eurosurgeonsshould always remember this clinical entity when following patients who were submitted to radiation therapy in the past.