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Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
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Reis RC, Yamashita RHG, Solla DJF, Ramin LF, Teixeira MJ, Pinto FCG. Treatment of Idiopathic Normal Pressure Hydrocephalus with a Novel Programmable Valve: Prospective Evaluation of Costs, Efficacy, and Safety. Asian J Neurosurg 2023; 18:548-556. [PMID: 38152509 PMCID: PMC10749867 DOI: 10.1055/s-0043-1771370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t -test or the Mann-Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time ( p < 0.001), but no difference was seen between groups ( p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393-1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.
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Affiliation(s)
- Rodolfo Casimiro Reis
- Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Laís Fajardo Ramin
- Neuroradiology Section, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Anzai A, Utino A, Katayama H, Spir IAZ, Nery MM, Anhesini M, Tiezzi OS, Spir PRN, Otani P, dos Santos CL, Tristão LS, Bernardo WM. Use of programmable valve versus fixed pressure valve in the treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:207-212. [PMID: 36888761 PMCID: PMC9983482 DOI: 10.1590/1806-9282.2023d692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Adriano Anzai
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | - Armelim Utino
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | - Haroldo Katayama
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | | | - Mary Martins Nery
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | - Mauricio Anhesini
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | | | - Patricia RN Spir
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | - Pericles Otani
- Unimed Presidente Prudente, Medicina Baseada em Evidências Center – Presidente Prudente (SP), Brazil
| | - Clara Lucato dos Santos
- Centro Universitário Lusíada, Faculdade de Ciências Médicas de Santos, Center for Evidence-Based Medicine – Santos (SP), Brazil
| | - Luca Schiliró Tristão
- Centro Universitário Lusíada, Faculdade de Ciências Médicas de Santos, Center for Evidence-Based Medicine – Santos (SP), Brazil
| | - Wanderley M. Bernardo
- Centro Universitário Lusíada, Faculdade de Ciências Médicas de Santos, Center for Evidence-Based Medicine – Santos (SP), Brazil
- Universidade de São Paulo, Guidelines Program of the Brazilian Medical Association – São Paulo (SP), Brazil
- Corresponding author:
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Ozdemir O, Yaz G, Diren F, Boyali O, Chasan M, Develioglu NO, Kabatas S, Civelek E. The Effects of Using Hearing Aids and Hearing Assistive Technologies on Programmable Ventriculoperitoneal Shunt. World Neurosurg 2022; 167:e567-e574. [PMID: 35995353 DOI: 10.1016/j.wneu.2022.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To investigate interaction between behind-the-ear (BTE) hearing aids, hearing assistive technologies, and programmable shunt valve to understand how use of BTE hearing aids in patients who underwent ventriculoperitoneal shunt (VPS) surgery affects the settings of a programmable shunt valve. METHODS In this study, we investigated the magnetic field (MF) generation of 3 BTE hearing aids made by different companies, 1 frequency modulated system using telecoil technology, and 1 wireless microphone technology and their interactions with 2 programmable shunt valves. All measurements were made in a silent booth using 2 different models. The influence of MF strength in the distance modeling was investigated based on the distance from source auditory prostheses. The measurements were recorded using a Gauss meter. In the anatomical modeling, the change in the settings and interaction of the valve in a bust mannequin were investigated. RESULTS No MF created by BTE hearing aids was detected in the distance modeling. The highest value measured was 32.67 μT (<90 dB noise) when BTE hearing aids and frequency modulated systems were used, and this value decreased as the distance increased. No MF generation was observed at measurements done for distances >10 mm. In the anatomical modeling, the settings of both programmable valves did not change under all acoustic conditions. CONCLUSIONS This is the first study to our knowledge examining the MF created by hearing aids and hearing assistive technologies and its impact on programmable valves and variations in their settings. Our findings showed that it is safe to use BTE hearing aids, frequency modulated systems, and wireless microphone technologies in patients with a programmable VPS.
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Affiliation(s)
- Omer Ozdemir
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey.
| | - Gokhan Yaz
- Department of Otolaryngology, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Furkan Diren
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Osman Boyali
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Mourat Chasan
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Necati Omer Develioglu
- Department of Otolaryngology, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Serdar Kabatas
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Erdinc Civelek
- Department of Neurosurgery, University of Health Sciences Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
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Trungu S, Scollato A, Ricciardi L, Forcato S, Polli FM, Miscusi M, Raco A. Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study. J Clin Med 2022; 11:jcm11051286. [PMID: 35268376 PMCID: PMC8911143 DOI: 10.3390/jcm11051286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59−86) and mean follow-up was 38.3 months (13−50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment.
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Affiliation(s)
- Sokol Trungu
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
- Correspondence:
| | - Antonio Scollato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | - Luca Ricciardi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Stefano Forcato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | | | - Massimo Miscusi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Antonino Raco
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
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de Oliveira MF, Sorte AAB, Emerenciano DL, Rotta JM, Mendes GAS, Pinto FCG. Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience. Acta Neurol Belg 2021; 121:1799-1806. [PMID: 33136273 DOI: 10.1007/s13760-020-01538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence and enlarged ventricular system due to disturbance of cerebrospinal fluid (CSF). This study aims to describe the long-term experience with patients with iNPH submitted to ventriculoperitoneal shunt (VPS) with the programmable valve STRATA® (Medtronic). We prospectively selected a cohort of patients with a diagnosis of iNPH from January 2010 to April 2013 in a Brazilian tertiary hospital. All patients underwent clinical evaluation, which consists of the Mini-Mental State Examination and Time Up and Go tests and the application of Japanese Scale for Idiopathic Normal Pressure Hydrocephalus in three stages: prior to the TT, 3 h after the TT and 72 h after the TT. Fifty patients were submitted to VPS and followed. There were 32 men and 18 women. Mean age was 77.1 with standard deviation of 10.9. Follow-up time ranged from 96 to 120 months, with mean of 106 months. After 1 year of follow-up, 42 (83%) patients presented with clinical improvement, decreasing to 62% of patients at mid-term follow-up and 38% of patients at late follow-up. Complications occurred in 18% of subjects, needing reoperation in 16%. Our results show relevant clinical impact of shunting in iNPH patients, decreasing over time. Complications should not be underestimated, reaching up to 18% and demanding reoperation in 16% of cases. Thus, although much has been improved with current shunt technology, it is still important to consider the drawbacks of treatment.
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Roblot P, Mollier O, Ollivier M, Gallice T, Planchon C, Gimbert E, Danet M, Renault S, Auzou N, Laurens B, Jecko V. Communicating chronic hydrocephalus: A review. Rev Med Interne 2021; 42:781-788. [PMID: 34144842 DOI: 10.1016/j.revmed.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Formerly called normal pressure hydrocephalus, communicating chronic hydrocephalus (CCH) is a condition affecting 0.1 to 0.5% of patients over 60years of age. The pathophysiology of this disease is poorly understood, but a defect in cerebrospinal fluid (CSF) resorption appears to be commonly defined as the cause of the neurological disorders. The last important discovery is the description of the glymphatic system and its implication in CCH and CSF resorption. Comorbidities (Alzheimer's disease, microangiopathy, parkinsonism) are very frequent, and involve a diagnostic challenge. The clinical presentation is based on the Hakim and Adams triad, comprising gait disorders, mainly impairing walking, cognitive disorders, affecting executive functions, episodic memory, visuospatial cognition, and sphincter disorders as urinary incontinence (detrusor hyperactivity). The diagnosis is suspected through a set of arguments, combining the clinical presentation, the radiological data of the magnetic resonance imaging (MRI) showing a ventriculomegaly associated with signs of transependymomous resorption of the CSF and disappearance of the cortical sulci, and the clinical response to the depletion of CSF. In the presence of all these elements, or a strong clinical suspicion, the standard treatment will be of a permanent CSF shunt, using a ventriculoatrial or ventriculoperitoneal shunt. The effectiveness of this treatment defines the diagnosis. The clinical improvement is better when treatment occurs early after the onset of the disorders, reaching 75 to 90% of motor improvement.
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Affiliation(s)
- P Roblot
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Laboratory of anatomy, university of Bordeaux, Bordeaux, France.
| | - O Mollier
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Ollivier
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Gallice
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Department of critical care, Bordeaux university hospital, 33076 Bordeaux, France
| | - C Planchon
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - E Gimbert
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Danet
- Department of geriatric medicine, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - S Renault
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - N Auzou
- Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - B Laurens
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - V Jecko
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Université de Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
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Wang HC, Tong YL, Li SW, Chen MS, Wang BD, Chen H. Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report. BMC Surg 2021; 21:154. [PMID: 33743657 PMCID: PMC7981930 DOI: 10.1186/s12893-021-01161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. CASE PRESENTATION This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. CONCLUSION To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).
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Affiliation(s)
- Hong-Cai Wang
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China
| | - Yi-Lei Tong
- Department of Internal Medicine, Ningbo Huamei Hospital University of Chinese Academy of Sciences, No. 41 Northwest Street, Ningbo, 315040, China
| | - Shi-Wei Li
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China
| | - Mao-Song Chen
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China.
| | - Bo-Ding Wang
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China
| | - Hai Chen
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China
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Pinto FCG, Oliveira MFD, Castro JPSD, Morais JVR, Pinto FMG, Teixeira MJ. Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:9-12. [PMID: 32074184 DOI: 10.1590/0004-282x20190135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. METHODS Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. RESULTS The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. DISCUSSION Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. CONCLUSION Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
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Affiliation(s)
- Fernando Campos Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Matheus Fernandes de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - João Paulo Souza de Castro
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - João Vitor Rocha Morais
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Flávia Morais Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
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Krahulik D, Vaverka M, Hrabalek L, Hampl M, Halaj M, Jablonsky J, Langova K. Ventriculoperitoneal shunt in treating of idiopathic normal pressure hydrocephalus-single-center study. Acta Neurochir (Wien) 2020; 162:1-7. [PMID: 31728709 DOI: 10.1007/s00701-019-04135-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECT Idiopathic normal pressure hydrocephalus (iNPH) is the only variant of dementia disorders possibly treatable by neurosurgical intervention. iNPH is a neurodegenerative condition clinically characterized by gait ataxia, urinary incontinence, and memory disturbance. We present one of the largest single-center studies, which was designed to prove efficacy of our low-pressure setting of gravitational valve at all three symptoms of iNPH and to find statistically significant cut-off time for best clinical improvement according to the duration of symptoms. METHODS Sixty-one consecutive patients (mean age 74.9 ± 5.3) with iNPH were prospectively observed from the time of surgery with minimal 6 months follow-up. All patients underwent implantation of the same type of gravitational valve with the same setting-pro GAV with low opening pressure at 5 cm H2O-and were operated by the same team of 2 neurosurgeons. We statistically evaluated gait disturbance, psychological changes, and incontinence preoperatively and at 6 months after surgery and timing of the surgery according to the duration of symptoms and to the age. RESULTS Paired t test showed a statistically significant increase in MMSE, a statistically significant decrease in 10-m walk test and 360 deg. rotation test (p < 0.0001). The correlation among the change of the MMSE, the walk test, and the rotation test, and the age and time of symptoms' duration was verified by Pearson's correlation coefficient. Pearson's correlation coefficient showed a medium strong correlation between the change of MMSE and the time of symptoms (r = - 0.580; p < 0.0001) and between the change of the number of steps and the time of symptoms (r = 0.517, p < 0.0001). There was a statistically significant weak (poor) correlation between the change of the walk test and the time of symptoms (r = 0.351, p = 0.006). All 3 ROC tests confirmed optimal cut-off for the best improvement of symptoms as 9.5 months of the symptom duration. CONCLUSIONS We proved statistical significant optimal cut-off for the best improvement of the symptoms as 9.5 months of the symptom duration. This study also confirmed successful treatment of iNPH with VP shunting using low pressure setting of gravitational valve with overall improvement in 75% and low over drainage complications in 5% We proved statistically significant increase in MMSE, decrease in 10 m walk test and number of steps test, p < 0.0001.
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Affiliation(s)
- David Krahulik
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic.
| | - Miroslav Vaverka
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic
| | - Lumir Hrabalek
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic
| | - Martin Hampl
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic
| | - Matej Halaj
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic
| | - Jakub Jablonsky
- Neurosurgical Clinic - Faculty Hospital Olomouc, I.P. Pavlova 6, 77520, Olomouc, Czech Republic
| | - Katerina Langova
- Department of Biophysics, Palacky University Olomouc, Olomouc, Czech Republic
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Baghbani R. An Electrical Model of Hydrocephalus Shunt Incorporating the CSF Dynamics. Sci Rep 2019; 9:9751. [PMID: 31278327 PMCID: PMC6611941 DOI: 10.1038/s41598-019-46328-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/26/2019] [Indexed: 01/18/2023] Open
Abstract
The accumulation of cerebrospinal fluid (CSF) in brain ventricles and subarachnoid space is known as hydrocephalus. Hydrocephalus is a result of disturbances in the secretion or absorption process of CSF. A hydrocephalus shunt is an effective method for the treatment of hydrocephalus. In this paper, at first, the procedures of secretion, circulation, and absorption of CSF are studied and subsequently, the mathematical relations governing the pressures in different interacting compartments of the brain are considered. A mechanical-electrical model is suggested based on the brain physiology and blood circulation. In the proposed model, hydrocephalus is modeled with an incremental resistance (Ro) and hydrocephalus shunt, which is a low resistance path to drain the accumulated CSF in the brain ventricles, is modeled with a resistance in series with a diode. At the end, the simulation results are shown. The simulation results can be used to predict the shunt efficiency in reducing CSF pressure and before a real shunt implementation surgery is carried out in a patient's body.
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Affiliation(s)
- R Baghbani
- Biomedical Engineering Department, Hamedan University of Technology, Hamedan, Iran.
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Lopes MIR, Tornai JB, Jeng FLDM, Lopes BDV, Mendes GADS, Oliveira MFD, Pinto FCG. Development of the Brazilian Portuguese version of the "Grading scale for idiopathic normal pressure hydrocephalus": cross-cultural adaptation, reliability and validity. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:692-696. [PMID: 30427509 DOI: 10.1590/0004-282x20180108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study translated to Portuguese and validated the normal pressure hydrocephalus (NPH) scale originally developed in English as the Grading Scale for Idiopathic Normal Pressure Hydrocephalus. METHODS Following Guillemin's validation protocol, the last version of the Portuguese NPH scale was applied to 121 consecutive patients with a diagnosis of normal pressure hydrocephalus (73 men and 48 women) from the Group of Cerebral Hydrodynamics from July 2010 to March 2012. RESULTS The mean age was 71.09 years old, ranging from 35 to 92 years. The rate of agreement and reproducibility was high, as confirmed by Cohen's Kappa coefficient, with excellent intraobserver correlation for the NPH scale items individually evaluated: gait (0.80), dementia (0.90) and incontinence (0.87). CONCLUSIONS The Portuguese version of the Grading Scale for Idiopathic Normal Pressure Hydrocephalus was successfully translated and validated for use in Brazilian patients.
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Affiliation(s)
- Maria Izabel Romão Lopes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Juliana Benevenuto Tornai
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Fernanda Letkaske de Miranda Jeng
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Bianca di Virgilio Lopes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brasil
| | - Gabriel André da Silva Mendes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brasil
| | - Matheus Fernandes de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurocirurgia, São Paulo SP, Brasil
| | - Fernando Campos Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
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Giordan E, Palandri G, Lanzino G, Murad MH, Elder BD. Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. J Neurosurg 2018; 131:1024-1036. [PMID: 30497150 DOI: 10.3171/2018.5.jns1875] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Different CSF diversion procedures (ventriculoperitoneal, ventriculoatrial, and lumboperitoneal shunting) have been utilized for the treatment of idiopathic normal pressure hydrocephalus. More recently, endoscopic third ventriculostomy has been suggested as a reasonable alternative in some studies. The purpose of this study was to perform a systematic review and meta-analysis to assess overall rates of favorable outcomes and adverse events for each of these treatments. An additional objective was to determine the outcomes and complication rates in relation to the type of valve utilized (fixed vs programmable). METHODS Multiple databases (PubMed, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) were searched for studies involving patients with idiopathic ventriculomegaly, no secondary cause of hydrocephalus, opening pressure < 25 mm Hg on high-volume tap or drainage trial, and age > 60 years. Outcomes included the proportion of patients who showed improvement in gait, cognition, and bladder function. Adverse events considered in the analysis included postoperative ischemic/hemorrhagic complications, subdural fluid collections, seizures, need for revision surgery, and infection. RESULTS A total of 33 studies, encompassing 2461 patients, were identified. More than 75% of patients experienced improvement after shunting, without significant differences among the different techniques utilized. Overall, gait improvement was observed in 75% of patients, cognitive function improvement in more than 60%, and improvement of incontinence in 55%. Adjustable valves were associated with a reduction in revisions (12% vs 32%) and subdural collections (9% vs 22%) as compared to fixed valves. CONCLUSIONS Outcomes did not differ significantly among different CSF diversion techniques, and overall improvement was reported in more than 75% of patients. The use of programmable valves decreased the incidence of revision surgery and of subdural collections after surgery, potentially justifying the higher initial cost associated with these valves.
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Affiliation(s)
| | - Giorgio Palandri
- 2IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Subramanian HE, Mahajan A, Sommaruga S, Falcone GJ, Kahle KT, Matouk CC. The Subjective Experience of Patients Undergoing Shunt Surgery for Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2018; 119:e46-e52. [DOI: 10.1016/j.wneu.2018.06.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022]
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15
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A simplified pressure adjustment clinical pathway for programmable valves in NPH patients. Clin Neurol Neurosurg 2017; 159:83-86. [DOI: 10.1016/j.clineuro.2017.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/17/2017] [Accepted: 05/20/2017] [Indexed: 11/17/2022]
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Thompson SD, Shand Smith JD, Khan AA, Luoma AMV, Toma AK, Watkins LD. Shunting of the over 80s in normal pressure hydrocephalus. Acta Neurochir (Wien) 2017; 159:987-994. [PMID: 28421283 DOI: 10.1007/s00701-017-3171-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus is predominantly a disease of the elderly. By its nature, many of those who present to clinic are in advanced old age with multiple comorbidities. Majority of patients treated are younger than 80 years old. We present the clinical outcomes and complication rates of patients over the age of 80 years at the time of operation, during the past 11 years at a single institution. METHODS Retrospective analysis of clinical records of all patients over the age of 80 years, who presented to our institution between 2006 and 2016. Results were analysed for co-morbidities, immediate and delayed complications, change in mobility/cognitive function post shunting of hydrocephalus. RESULTS 39 patients (24 male, 15 female) met criteria. Mean [SD] age at the time of shunt insertion was 84 years (+/- 3.22) (range 80-94). No patients developed immediate CSF infection or sub-dural collection, or extended length of stay due to surgical or anaesthetic complications. There were no peri-operative or anaesthetic complications. 4 patients required a delayed surgical revision to encourage greater CSF drainage. 3 patients went on to develop delayed subdural haematoma, 1 of which was associated with trauma, 2 through overdrainage. 1 patient experienced poor post-operative wound healing and subsequently underwent removal of shunt. Of the 34 patient followed up, 27 patients (79.4%) improved in their mobility. (64.7%) patients/families reported symptomatic improvement in their cognition and memory. 6 (17.7%) patients did not experience an improvement in either mobility or cognitive function. CONCLUSIONS Our data supports the assertion that, with proper patient selection, shunting of the over 80s with iNPH is a safe and effective procedure.
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Affiliation(s)
- Simon D Thompson
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - J D Shand Smith
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - A A Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - A M V Luoma
- Department of Neuroanaesthesia and Neurocritical Care, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - A K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - L D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Yang L, Wang X, Li Y, Chen L, Yan Z, She L, Dong J. The Clinical Effect of Postoperative Hyperbaric Oxygen Therapy on Idiopathic Normal Pressure Hydrocephalus: A Retrospective and Comparative Analysis of 61 Patients with Ventriculoperitoneal Shunt. World Neurosurg 2017; 104:376-380. [PMID: 28502690 DOI: 10.1016/j.wneu.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to examine the clinical effect of postoperative hyperbaric oxygen (HBO) therapy on symptoms and signs in the ventriculoperitoneal (VP) shunt insertion treatment of idiopathic normal pressure hydrocephalus (iNPH). METHODS We conducted a retrospective analysis of 61 patients treated at our institution for iNPH since 2007. Patients were stratified into 2 groups according to undergoing pure VP shunt with gravitational valves (group 1) or combined with postoperative HBO therapy (group 2). Clinical improvements as well as complications were compared between the 2 groups. RESULTS There was no significant difference between the 2 groups regarding age, sexual proportion, body mass index, education years, and the average Normal Pressure Hydrocephalus Scale score before the surgery, as well as the complication rate after the surgery (P > 0.05). On average, the total Normal Pressure Hydrocephalus Scale scores were both increased in the 2 groups at 1, 3, and 6 months after shunting, with no significant differences (P > 0.05). However, group 2 tended to increase more compared with group 1, especially 6 months later after shunting. The increase of cognitive functions was more significant in group 2 (P < 0.05). CONCLUSIONS HBO therapy combined with VP shunt is expected to improve the effect of iNPH treatment, especially for cognitive performance.
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Affiliation(s)
- Lin Yang
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Jiangsu Province, China; Department of Neurosurgery, Yizheng People's Hospital, Yizheng, Jiangsu Province, China
| | - Xingdong Wang
- Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu Province, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu Province, China
| | - Lang Chen
- Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu Province, China
| | - Zhengcun Yan
- Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu Province, China
| | - Lei She
- Department of Neurosurgery, Clinical Medical College of Yang Zhou University, Yangzhou, Jiangsu Province, China
| | - Jun Dong
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Jiangsu Province, China.
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Transcranial Doppler in the evaluation of infants treated with retrograde ventriculosinus shunt. Childs Nerv Syst 2016; 32:2133-2142. [PMID: 27638718 DOI: 10.1007/s00381-016-3237-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hydrocephalus is a prevalent condition among infants. Retrograde ventriculosinus shunt (RVSS) proposes a feasible option to treat hydrocephalus according to the principles presented by El-Shafei. In this essay, we analyze nuances and application of transcranial Doppler (TCD) in patients submitted to RVSS. METHODS We consecutively enrolled patients diagnosed with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012, users of Hospital das Clinicas, University of Sao Paulo. They were treated with RVSS. Patients enrolled to the study were consecutively evaluated in an outpatient basis with TCD in preoperative, immediate postoperative period, and late postoperative period (1 year). RESULTS Except for patient 3, there was an increase in mean flow velocity, decreased pulsatility index, and decreased resistance index in all vessels analyzed. DISCUSSION In our sample, transcranial Doppler could be used as a diagnostic and follow-up tool to evaluate hemodynamics and hydrodynamics in the preoperative and postoperative phases of RVSS. It was technically feasible in all patients, had close relation with other clinical and image parameters, and was sensitive to identify system malfunction.
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Oliveira MFD, Teixeira MJ, Norremose KA, Matushita H, Oliveira MDL, Shu EBS, Pinto FCG. Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:1019-25. [DOI: 10.1590/0004-282x20150169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/24/2015] [Indexed: 11/21/2022]
Abstract
ABSTRACT Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.
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Pereira RM, Suguimoto MT, Oliveira MF, Tornai JB, Amaral RA, Teixeira MJ, Pinto FCG. Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 74:55-61. [PMID: 26602193 DOI: 10.1590/0004-282x20150190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/05/2015] [Indexed: 05/28/2023]
Abstract
Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.
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Affiliation(s)
| | | | - Matheus F Oliveira
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Juliana B Tornai
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo A Amaral
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Oliveira MFD, Reis RC, Trindade EM, Pinto FCG. Evidences in the treatment of idiopathic normal pressure hydrocephalus. Rev Assoc Med Bras (1992) 2015; 61:258-62. [PMID: 26248249 DOI: 10.1590/1806-9282.61.03.258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/26/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. METHODS an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. RESULTS the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. CONCLUSION well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.
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Oliveira MF, Oliveira JRM, Rotta JM, Pinto FCG. Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:435-8. [PMID: 24964110 DOI: 10.1590/0004-282x20140047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 03/26/2014] [Indexed: 11/22/2022]
Abstract
Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.
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Affiliation(s)
- Matheus F Oliveira
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, SP, Brazil
| | - João R M Oliveira
- Laboratório Keizo Asami, Universidade Federal do Recife, Recife, PE, Brazil
| | - José M Rotta
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, SP, Brazil
| | - Fernando C G Pinto
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, SP, Brazil
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Gomes Pinto FC, de Oliveira MF. Response to journal club: role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial. Neurosurgery 2013; 73:911-2. [PMID: 24141399 DOI: 10.1227/neu.0000000000000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fernando Campos Gomes Pinto
- *Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil; ‡Neurosurgery Residency Program-Department of Neurosurgery-Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
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