Desarrollo de una solución integrada para pacientes con dolor crónico portadores de neuroestimulador en tiempos del COVID-19: una aplicación para móvil con centro de soporte / Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center

Introducción El dolor crónico es una de las afecciones más prevalentes en el mundo. El tratamiento con neuroestimuladores se realiza en los casos más extremos tras una cuidadosa selección, y demanda una gran inversión de recursos en su seguimiento. En estos momentos de pandemia por la COVID-19, presentamos una solución integrada para el seguimiento de estos de pacientes, que incluye el desarrollo de una aplicación para dispositivos móviles y un centro de soporte para seguimiento remoto (CSSR). Material y metodología El proyecto se ha desarrollado basándose en evidencia científica en las siguientes fases: 1) Aprobación de la idea en sesión clínica multidisciplinar de implantes para dolor crónico, 2) Formación de un grupo de expertos, 3) Adaptación del protocolo para el seguimiento de los pacientes con dolor crónico a las características del entorno de un smartphone, 4) Adaptación de la plataforma tecnológica al protocolo clínico (entorno tecnológico y flujo de trabajo entre el hospital y el CSSR) y 5) Evaluación de la calidad mediante encuesta (cuantitativa y cualitativa) con una pequeña muestra de pacientes. Resultados La aplicación de paciente se evaluó solicitando opiniones de los usuarios sobre el diseño y la utilidad de la misma entre los primeros pacientes implantados que la usaron. Se realizaron algunos ajustes menores en relación con el material para descargar, y sobre el texto y el color de la pantalla. Conclusiones El proceso de creación de una solución integrada debe estar basado en principios científicos y acorde con los protocolos establecidos. Un centro de soporte permite asegurar una mayor adherencia al seguimiento y una mejor atención a los pacientes (AU)

Introduction Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of COVID-19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MMaterial and methodology The project was developed according to the scientific evidence in the following phases: (1) approval in a multidisciplinary clinical committee of implants for chronic pain, (2) setting up a group of experts, (3) protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) quality evaluation by survey (quantitative and qualitative) of a small series of patients. Results The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. Conclusions Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care (AU)

[Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center]. / Desarrollo de una solución integrada para pacientes con dolor crónico portadores de neuroestimulador en tiempos del COVID-19: una aplicación para móvil con centro de soporte.

Introduction: Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of COVID-19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MMaterial and methodology: The project was developed according to the scientific evidence in the following phases: (1) approval in a multidisciplinary clinical committee of implants for chronic pain, (2) setting up a group of experts, (3) protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) quality evaluation by survey (quantitative and qualitative) of a small series of patients. Results: The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. Conclusions: Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care.

Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center.

INTRODUCTION: Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of the COVID19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MATERIAL AND METHODOLOGY: The project was developed according to the scientific evidence in the following phases: (1) Approval in a multidisciplinary clinical committee of implants for chronic pain, (2) Setting up a group of experts, (3) Protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) Technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) Quality evaluation by survey (quantitative and qualitative) of a small series of patients. RESULTS: The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. CONCLUSIONS: Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care.

High-frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation.

BACKGROUND: This study aims to evaluate the efficacy of 10-kHz high-frequency (HF10) devices as a rescue treatment in patients with failure of conventional spinal cord stimulation (SCS) therapy for chronic pain without the need to change the spinal hardware. METHODS: In this real-world prospective study, patients with neuropathic pain treated with conventional tonic SCS in whom the therapy had failed, either during the trial phase or after a period of optimal functioning, were recruited throughout 2 years for HF10-SCS therapy. Data on analgesia, functionality, analgesics use and treatment safety were collected 12 months after treatment. RESULTS: Eleven of the 18 (61%) patients included in the study were successfully rescued with HF10-SCS. Of them, 5 out of 12 (45%) were in the trial phase and six out of six (100%) had previously functioning implants. A significant improvement in low-back and limb pain was obtained (p = 0.003 and p = 0.0001, respectively). Treatment success was significantly associated with gender (p = 0.037), weight (p = 0.014), body mass index (BMI) (p = 0.007) and time of rescue (p = 0.015). A linear regression test confirmed a significant association between treatment failure and BMI and gender (p = 0.004). CONCLUSIONS: Our results suggest that analgesic rescue with HF10-SCS is an effective therapeutic option for non-responders to conventional SCS, although obesity might be a limiting factor for treatment success. Nevertheless, more comprehensive studies are needed to corroborate our findings. SIGNIFICANCE: This study shows that high-frequency stimulation may be useful in patients with failure of conventional tonic stimulation for chronic pain, both in the trial phase and in previously implanted subjects. The novelty of this study lies in the use of the implanted epidural electrodes, which avoids the need for further surgery. The results in terms of pain control and recovery of functionality are satisfactory. In addition, variables such as male gender and high body mass index could be predictors of therapy failure.

Estudio retrospectivo para evaluar la eficacia y la seguridad de la radiocirugía en enfermedad de Cushing: 24 casos y revisión / Retrospective analysis to evaluate efficacy and safety of stereotactic radiosurgery in Cushing's disease: 24 cases and a review

Introducción: En los últimos años la radiocirugía (RC) se ha postulado como una buena alternativa terapéutica, por lo general de segunda línea, en el manejo de los adenomas hipofisarios productores de ACTH. Se realiza un estudio retrospectivo para evaluar la eficacia y la seguridad de dicho tratamiento en estos pacientes. Material y métodos: Se recogieron datos de los pacientes tratados mediante RC por adenoma hipofisario productor de ACTH entre 1996 y 2008, con al menos un año de seguimiento, analizando la tasa de normalización hormonal y mejoría clínica (estigmas del síndrome de Cushing, hipertensión arterial), así como la aparición de efectos adversos y de recidiva. Se consideró normalización hormonal -y por tanto curación- como una tasa normal de cortisol libre urinario (CLU) en 24 h (< 100 μg/día). Resultados: Treinta pacientes fueron tratados, de los que 24 entraron en el estudio. Todos ellos tenían cifras elevadas de CLU previamente al tratamiento con RC. La curación se consiguió en 12 (50%), en un promedio de 28meses, y en otros 3 pacientes se normalizaron las cifras de CLU con tratamiento con ketoconazol posterior. En todos mejoraron los estigmas de Cushing, y en 13 (de 14) mejoró la HTA. No se evidenció ningún caso de recidiva una vez instaurada la curación. Entre las complicaciones destacan 9 déficits hormonales nuevos (siendo el más frecuente el hipotiroidismo), una radionecrosis y un empeoramiento de la campimetría previa. No se encontró ningún caso de tumor radioinducido. Conclusiones: La RC es un tratamiento efectivo para aquellos pacientes con adenoma productor de ACTH en que la cirugía ha fallado o que no son candidatos a la misma, consiguiéndose buenas tasas de normalización hormonal y de control clínico de la enfermedad, con un bajo porcentaje de efectos adversos

Background: In the past few years, stereotactic radiosurgery (SRS) has been suggested as a good alternative, second line therapy for the management of patients with ACTH-secreting pituitary adenomas. A retrospective study has been conducted in order to evaluate the efficacy and safety of this treatment in these patients. Material and methods: Data were collected on all patients treated with SRS for an ACTH-secreting pituitary adenoma between 1996 and 2008, and with at least one year of follow-up. An analysis was carried out by analysing the return to normal of the hormone levels and clinical improvement rates (including Cushing signs, arterial hypertension), as well as adverse effects, and disease relapse. A return to normal of the 24hour urinary free cortisol (24-UFC) levels (<100μg/day) without any ACTH-secretion suppressor drug treatment, was considered as cure or improvement. Results: A total of 30 patients were treated with SRS, of which 24 were included in the analysis. They all had high 24-UFC levels before the treatment. Cure was achieved in 12 (50%) in a mean of 28months, and in other 3 patients 24-UFC levels returned to normal with treatment with ketoconazole after the SRS. Cushing signs improved in all cases, as well as arterial hypertension in 13 out of 14 cases. There were relapses after cure consolidation. As far as adverse effects, it should be mentioned that there were 9 cases of new pituitary hormonal dysfunction (the most frequent being hypothyroidism), one radionecrosis, and one case of visual field defect impairment. Radiation-related neoplasm was not detected in any of the cases. Conclusions: SRS is an effective treatment for those patients with ACTH-secreting pituitary adenoma in whom surgery has failed, or in those that are not good candidates for it. It showed good rates of hormone levels returning to normal, as well as clinical disease control and a low level of adverse effects

[Retrospective analysis to evaluate efficacy and safety of stereotactic radiosurgery in Cushing's disease: 24 cases and a review]. / Estudio retrospectivo para evaluar la eficacia y la seguridad de la radiocirugía en enfermedad de Cushing: 24 casos y revisión.

BACKGROUND: In the past few years, stereotactic radiosurgery (SRS) has been suggested as a good alternative, second line therapy for the management of patients with ACTH-secreting pituitary adenomas. A retrospective study has been conducted in order to evaluate the efficacy and safety of this treatment in these patients. MATERIAL AND METHODS: Data were collected on all patients treated with SRS for an ACTH-secreting pituitary adenoma between 1996 and 2008, and with at least one year of follow-up. An analysis was carried out by analysing the return to normal of the hormone levels and clinical improvement rates (including Cushing signs, arterial hypertension), as well as adverse effects, and disease relapse. A return to normal of the 24 hour urinary free cortisol (24-UFC) levels (<100 µg/day) without any ACTH-secretion suppressor drug treatment, was considered as cure or improvement. RESULTS: A total of 30 patients were treated with SRS, of which 24 were included in the analysis. They all had high 24-UFC levels before the treatment. Cure was achieved in 12 (50%) in a mean of 28 months, and in other 3 patients 24-UFC levels returned to normal with treatment with ketoconazole after the SRS. Cushing signs improved in all cases, as well as arterial hypertension in 13 out of 14 cases. There were relapses after cure consolidation. As far as adverse effects, it should be mentioned that there were 9 cases of new pituitary hormonal dysfunction (the most frequent being hypothyroidism), one radionecrosis, and one case of visual field defect impairment. Radiation-related neoplasm was not detected in any of the cases. CONCLUSIONS: SRS is an effective treatment for those patients with ACTH-secreting pituitary adenoma in whom surgery has failed, or in those that are not good candidates for it. It showed good rates of hormone levels returning to normal, as well as clinical disease control and a low level of adverse effects.

Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna / Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri

Objetivo: Evaluar la utilidad del análisis del registro de presión intracraneal (PIC) en el diagnóstico de la hipertensión intracraneal benigna (HIB). Material y métodos: Diez pacientes con sospecha clínica de HIB en los que no se cumplen por completo los criterios diagnósticos. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de la PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6meses de la intervención. Resultados: Todos los pacientes fueron mujeres jóvenes. La PIC media no fue superior a los 250 mmH2O en 5 de los 8 pacientes con registros patológicos. El análisis morfológico del trazado evidencia ondas A en un porcentaje elevado de pacientes (62,5%), correlacionándose en general con PIC media más elevada, aunque esta situación no se correspondió de forma sistemática con presencia de papiledema. Las ondas B de alta amplitud estuvieron presentes en todos los registros. La amplitud del registro fue superior a 5mmHg en la mayoría de los casos considerados patológicos. Todos los pacientes tratados conforme a los criterios de monitorización de PIC experimentaron mejoría tras la intervención. No hubo complicaciones relacionadas con el procedimiento de monitorización. Conclusiones: Los datos clínicos y de exploración son en ocasiones insuficientes para establecer el diagnóstico de HIB, especialmente en los casos en que el paciente ha sido tratado médica o quirúrgicamente con anterioridad. La monitorización de la PIC es un método seguro y fiable, útil en el diagnóstico de esta entidad. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta a la derivación. La amplitud del trazado expresa la complianza cerebral y es un dato relacionado también con respuesta a la derivación

Objectives. To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). Material and methods: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6months after surgery. Results: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. Conclusions: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well

Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución / Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults

Objetivo: Evaluar la utilidad del análisis del registro de la presión intracraneal (PIC) en el manejo de pacientes con marcada ventriculomegalia de larga evolución. Material y métodos: Veintidós pacientes con ventriculomegalia radiológica y clínica neurológica. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6 meses de la intervención. Resultados: Las edades oscilaron entre los 20 y los 70 años, con una media de 44 años. El síntoma de consulta más frecuente fue la cefalea. Los índices de Evans oscilaron entre 0,35 y 0,66, con una media de 0,47. El 55% asociaban estenosis de acueducto de Silvio. La PIC media fue superior a 12 mmHg en solo el 9% de los pacientes, en tanto que el análisis morfológico de los trazados catalogó al 64% de los mismos como patológicos. El análisis morfológico del trazado evidencia ondas A premeseta en 7 pacientes y ondas B en 20 pacientes (14 de ellos con ondas B de alta amplitud). Se consideraron patológicos y por tanto candidatos a cirugía a 14 pacientes, de los que 12 aceptaron la intervención (derivación de líquido cefalorraquídeo o ventriculostomía). El 70% de ellos habían experimentado mejoría a los 6 meses. No hubo complicaciones relacionadas con la monitorización. Conclusiones: La monitorización de la PIC es un método seguro y fiable, útil en el manejo de esta entidad, que permite seleccionar los pacientes candidatos a cirugía. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta al shunt

Objectives: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. Material and methods: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. Results: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. 'Pre-plateau' A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. Conclusions: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response

[Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri]. / Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna.

OBJECTIVES: To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). MATERIAL AND METHODS: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6 months after surgery. RESULTS: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. CONCLUSIONS: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well.

[Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults]. / Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución.

OBJECTIVES: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. MATERIAL AND METHODS: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. RESULTS: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. "Pre-plateau" A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. CONCLUSIONS: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response.

Hidrocefalia crónica del adulto: diagnóstico, tratamiento y evolución. Estudio prospectivo / Adult chronic idiopathic hydrocephalus-diagnosis, treatment and evolution. Prospective study

INTRODUCCIÓN: Actualmente la hidrocefalia crónica del adulto (HCA) se presenta como una patología de diagnóstico controvertido en la que se han usado múltiples técnicas diagnósticas y terapéuticas con diferentes grados de éxito postoperatorio. El objetivo de nuestro estudio es evaluar una serie de pacientes diagnosticados de HCA idiopática y tratados con derivación de LCR en nuestro centro entre los años 2006 y 2009 mediante escalas clínicas y controles radiológicos pre y postoperatoriamente. MATERIAL Y MÉTODOS: Se analizan prospectivamente 40 pacientes. El diagnóstico de HCA idiopática se hizo cuando el paciente cumplía 3 tipos de criterios: a) clínicos, b) radiológicos (Evans > 0,3) y c) hidrodinámicos (test de infusión de Katzman con Rout [mmHg/ml/min] > 12) o monitorización de la PIC patológica (ondas B en más del 20% del registro nocturno). Se colocó una DVP de baja presión GAV 5/35 en todos los casos. Se realizaron revisiones clínicas a los 3, 6 y 12 meses y radiológicas a los 6 meses de la intervención, así como encuesta de satisfacción a los 12 meses. Se valoró la mejoría clínica del paciente mediante las escalas de puntuación NPH, RANKIN modificado y PFEIFFER modificado. RESULTADOS: El estudio de los factores de riesgo (edad, sexo, fumador, bebedor, HTA, DM, dislipidemia) no estableció relaciones estadísticamente significativas. Se evidenció mejoría global estadísticamente significativa (p < 0,01) en los test de Rankin y NPH a los 3, 6 y 12 meses, siendo las cifras: NPH 73, 74 y 64%, y RANKIN 54, 72 y 56% de mejoría, respectivamente. En el PFEIFFER solo se evidenció mejoría significativa a los 12 meses. Dichas mejorías se clasificaron en niveles (elevada, moderada, leve y no mejoría). El índice de Evans inicial medio fue 0,385, postoperatorio 0,3675. Solo ocurrió una infección del sistema valvular (2%), sin secuelas. La mortalidad y la morbilidad relacionadas con el procedimiento fueron del 0%. CONCLUSIÓN: Una adecuada selección de los pacientes con criterios clínicos, radiológicos, hidrodinámicos y de monitorización de la PIC permite la obtención de buenos resultados con bajo índice de complicaciones

INTRODUCTION: At present, chronic hydrocephalus or normal pressure hydrocephalus (NPH) has a controversial diagnosis in which multiple diagnostic and therapeutic techniques have been used with variable degrees of postoperative success. The aim of our study is to evaluate a number of patients diagnosed with adult chronic idiopathic hydrocephalus who were treated with a CSF shunt at our centre between 2006 and 2009 through clinical scales and radiological controls pre- and postoperatively. MATERIAL AND METHODS: We prospectively analysed 40 patients. The diagnosis of idiopathic NPH was established when patients met 3 criteria: (I) clinical; (II) radiological (Evans >0.3), and (III) hydrodynamic (Katzman infusion test with Rout > 12) or pathological ICP monitoring (B waves in over 20% of a nocturnal registration). We used a low-pressure DVP 5/35 GAV in all cases. Clinical assessments were conducted at 3, 6 and 12 months and radiological assessments at 6 months postoperatively. The clinical improvement of patients was assessed with the NPH, modified RANKIN and modified PFEIFFER rating scales. RESULTS: The study of risk factors (age, gender, smoking, drinking, arterial hypertension, diabetes mellitus, dyslipidemia) did not establish statistically significant relationships. A statistically significant improvement was observed (P<.01) in the NPH and RANKIN tests at 3, 6 and 12 months. Clinical improvement values obtained were: NPH 73%, 74% and 64%, and RANKIN 54%, 72% and 56%, respectively. The PFEIFFER scale only showed a significant improvement at 12 months. These improvements were classified into various levels (high, moderate, mild and no improvement). The initial mean Evans index was 0.385, and 0.3675 postoperatively. There was only one infection of the valvular system (2%) without further complications. Morbidity and mortality related to the procedure were 0%. CONCLUSION: An appropriate selection of patients through clinical, radiological, hydrodynamic and ICP monitoring criteria enables us to obtain good results and a low complication rate

[Adult chronic idiopathic hydrocephalus-diagnosis, treatment and evolution. Prospective study]. / Hidrocefalia crónica del adulto: diagnóstico, tratamiento y evolución. Estudio prospectivo.

INTRODUCTION: At present, chronic hydrocephalus or normal pressure hydrocephalus (NPH) has a controversial diagnosis in which multiple diagnostic and therapeutic techniques have been used with variable degrees of postoperative success. The aim of our study is to evaluate a number of patients diagnosed with adult chronic idiopathic hydrocephalus who were treated with a CSF shunt at our centre between 2006 and 2009 through clinical scales and radiological controls pre- and postoperatively. MATERIAL AND METHODS: We prospectively analysed 40 patients. The diagnosis of idiopathic NPH was established when patients met 3 criteria: (i)clinical; (ii)radiological (Evans >0.3), and (iii)hydrodynamic (Katzman infusion test with Rout >12) or pathological ICP monitoring (B waves in over 20% of a nocturnal registration). We used a low-pressure DVP 5/35 GAV in all cases. Clinical assessments were conducted at 3, 6 and 12 months and radiological assessments at 6 months postoperatively. The clinical improvement of patients was assessed with the NPH, modified RANKIN and modified PFEIFFER rating scales. RESULTS: The study of risk factors (age, gender, smoking, drinking, arterial hypertension, diabetes mellitus, dyslipidemia) did not establish statistically significant relationships. A statistically significant improvement was observed (P<.01) in the NPH and RANKIN tests at 3, 6 and 12 months. Clinical improvement values obtained were: NPH 73%, 74% and 64%, and RANKIN 54%, 72% and 56%, respectively. The PFEIFFER scale only showed a significant improvement at 12 months. These improvements were classified into various levels (high, moderate, mild and no improvement). The initial mean Evans index was 0.385, and 0.3675 postoperatively. There was only one infection of the valvular system (2%) without further complications. Morbidity and mortality related to the procedure were 0%. CONCLUSION: An appropriate selection of patients through clinical, radiological, hydrodynamic and ICP monitoring criteria enables us to obtain good results and a low complication rate.