PDF herunterladen
Nervenheilkunde 2012; 31(09): 640-644
DOI: 10.1055/s-0038-1628291
Serie iNPH
Schattauer GmbH

Therapie und Prognose des iNPH

Therapy and prognosis for idiopathic normal pressure hydrocephalus
U. Meier
1   Klinik für Neurochirurgie, Unfallkrankenhaus Berlin
,
J. Lemcke
1   Klinik für Neurochirurgie, Unfallkrankenhaus Berlin
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingegangen am: 21. Februar 2012

angenommen am: 03. März 2012

Publikationsdatum:
23. Januar 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Ventikuloperitoneale Shunts stellen die Standardtherapie des idiopathischen Normaldruckhydrozephalus dar. Die Entwicklung der Ventiltechnologien ging von einfachen Differenzdruckventilen aus und führte über programmierbare Ventile hin zu modernen programmierbaren Ventilen mit Gravitationseinheit. Im Rahmen dieser Entwicklung konnten die Effektivität der Therapie gesteigert und die Komplikationsrate gesenkt werden. Prognostisch hat sich die Zahl der Shuntresponder von ca. 60% in den 1960er-Jahren bis heute auf bis zu 90% gesteigert.

Summary

Venticuloperitoneal shunts represent the standard therapy for patients with idiopathic normal pressure hydrocephalus. The development of valve technologies started from simple differential pressure valves and led over programmable valves to programmable valves with gravitational unit. During this development the effectiveness of the valves could be improved while the rate of complication was lowered. The proportion of shunt responders raised from 60% in the 1960s to 90% today.

Schlüsselwörter

Idiopathischer Normaldruckhydrozephalus - ventrikuloperitonealer Shunt - Gravitationsventil - SVASONA-Studie - Prognose

Keywords

Idiopathic normal pressure hydrocephalus - ventriculoperitoneal shunt - gravitational valve - SVASONA study - prognosis
 

  • Literatur

  • 1 Esmonde T, Cooke S. Shunting for normal pressure hydrocephalus (NPH). Cochrane Database Syst Rev 2002; (3): CD003157.
    PubMedSuche in Google Scholar
  • 2 Dandy WE. Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 1918; 68 (Suppl. 06) 569-79.
    CrossrefPubMedSuche in Google Scholar
  • 3 Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurg Rev 1999; 22 2–3 67-93.
    CrossrefPubMedSuche in Google Scholar
  • 4 Aschoff A, Kremer P, Benesch C, Fruh K, Klank A, Kunze S. Overdrainage and shunt technology. A critical comparison of programmable, hydrostatic and variable-resistance valves and flow-reducing devices. Childs Nerv Syst 1995; 11 (Suppl. 04) 193-202.
    CrossrefPubMedSuche in Google Scholar
  • 5 Aschoff A, Kramer P, Benesch C, Klank A. Shunt-technology and overdrainage – a critical review of hydrostatic, programmable and variable-resistance-valves and flow-reducing devices. Eur J Pediatr Surg 1991; 1 Suppl 1: 49-50.
    Thieme ConnectPubMedSuche in Google Scholar
  • 6 Czosnyka Z, Czosnyka M, Richards HK, Pickard JD. Laboratory testing of hydrocephalus shunts – conclusion of the U.K. Shunt evaluation programme. Acta Neurochir (Wien) 2002; 144 (Suppl. 06) 525-38.
    CrossrefPubMedSuche in Google Scholar
  • 7 Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J. The Dutch normal-pressure hydrocephalus study. How to select patients for shunting?. An analysis of four diagnostic criteria. Surg Neurol 2000; 53 (Suppl. 03) 201-7.
    PubMedSuche in Google Scholar
  • 8 Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J. Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 1998; 88 (Suppl. 03) 490-5.
    CrossrefPubMedSuche in Google Scholar
  • 9 de Jong DA, Delwel EJ, Avezaat CJ. Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochir (Wien) 2000; 142 (Suppl. 03) 241-7.
    CrossrefPubMedSuche in Google Scholar
  • 10 Frim DM, Goumnerova LC. In vivo intracranial pressure dynamics in patients with hydrocephalus treated by shunt placement. J Neurosurg 2000; 92 (Suppl. 06) 927-32.
    CrossrefPubMedSuche in Google Scholar
  • 11 Kiefer M, Eymann R, Meier U. Five years experience with gravitational shunts in chronic hydrocephalus of adults. Acta Neurochir (Wien) 2002; 144 (Suppl. 08) 755-67.
    CrossrefPubMedSuche in Google Scholar
  • 12 Meier U, Kiefer M, Sprung C. Evaluation of the Miethke dual-switch valve in patients with normal pressure hydrocephalus. Surg Neurol 2004; 61 (Suppl. 02) 119-27.
    CrossrefPubMedSuche in Google Scholar
  • 13 Sprung C, Schlosser HG, Lemcke J, Meier U, Messing-Junger M, Trost HA, Weber F, Schul C, Rohde V, Ludwig HC, Hopfner J, Sepehrnia A, Mirzayan MJ, Krauss JK. The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery 2010; 66 (Suppl. 03) 465-74.
    CrossrefPubMedSuche in Google Scholar
  • 14 Zeilinger FS, Reyer T, Meier U, Kintzel D. Clinical experiences with the dual-switch valve in patients with normal pressure hydrocephalus. Acta Neurochir Suppl 2000; 76: 559-62.
    PubMedSuche in Google Scholar
  • 15 Meier U, Kiefer M, Neumann U, Lemcke J. On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal-pressure hydrocephalus: a prospective randomized study with 123 patients. Acta Neurochir Suppl 2006; 96: 358-63.
    PubMedSuche in Google Scholar
  • 16 Meier U. Outcome of idiopathic normal pressure hydrocephalus after surgery with gravity valves. Neurosurg Q 2004; 14: 119-26.
    CrossrefSuche in Google Scholar
  • 17 Lemcke J, Meier U. Improved outcome in shunted iNPH with a combination of a Codman Hakim Programmable Valve and an Aesculap-Miethke ShuntAssistant. Central European Neurosurgery 2010; 71 (Suppl. 03) 113-6.
    Thieme ConnectPubMedSuche in Google Scholar
  • 18 Meier U, Lemcke J. First clinical experiences in patients with idiopathic normal-pressure hydrocephalus with the adjustable gravity valve manufactured by Aesculap (proGAV). Acta Neurochir Suppl 2006; 96: 368-72.
    PubMedSuche in Google Scholar
  • 19 Lemcke J, Meier U, Muller C, Fritsch M, Eymann R, Kiefer M, Kehler U, Langer N, Rohde V, Ludwig HC, Weber F, Remenez V, Schuhmann M, Stengel D. Is it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698). Acta Neurochir Suppl 2010; 106: 113-5.
    PubMedSuche in Google Scholar
  • 20 Meier U, Lemcke J. Diagnostic methods of norm-alpressure hydrocephalus. Schweiz Arch Neurol Psychiatr 2007; 158: 139-49.
    Suche in Google Scholar
  • 21 Meier U, Lemcke J, Neumann U. Predictors of outcome in patients with normal-pressure hydrocephalus. Acta Neurochir Suppl 2006; 96: 352-7.
    PubMedSuche in Google Scholar
  • 22 Sorteberg A, Eide PK, Fremming AD. A prospective study on the clinical effect of surgical treatment of normal pressure hydrocephalus: the value of hydrodynamic evaluation. Br J Neurosurg 2004; 18 (Suppl. 02) 149-57.
    CrossrefPubMedSuche in Google Scholar
  • 23 Poca MA, Mataro M, del Mar MM, Arikan F, Junque C, Sahuquillo J. Is the placement of shunts in patients with idiopathic normal-pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure. J Neurosurg 2004; 100 (Suppl. 05) 855-66.
    CrossrefPubMedSuche in Google Scholar
  • 24 Murakami M, Hirata Y, Kuratsu JI. Predictive assessment of shunt effectiveness in patients with idiopathic normal pressure hydrocephalus by determining regional cerebral blood flow on 3D stereotactic surface projections. Acta Neurochir (Wien) 2007; 149 (10) 991-7.
    CrossrefPubMedSuche in Google Scholar
  • 25 Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol 2006; 2 (Suppl. 07) 375-81.
    CrossrefPubMedSuche in Google Scholar
  • 26 Chang S, Agarwal S, Williams MA, Rigamonti D, Hillis AE. Demographic factors influence cognitive recovery after shunt for normal-pressure hydrocephalus. Neurologist 2006; 12 (Suppl. 01) 39-42.
    CrossrefPubMedSuche in Google Scholar
  • 27 Duinkerke A, Williams MA, Rigamonti D, Hillis AE. Cognitive recovery in idiopathic normal pressure hydrocephalus after shunt. Cogn Behav Neurol 2004; 17 (Suppl. 03) 179-84.
    CrossrefPubMedSuche in Google Scholar
  • 28 Graff-Radford NR, Godersky JC. Normal-pressure hydrocephalus. Onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 1986; 43 (Suppl. 09) 940-2.
    CrossrefPubMedSuche in Google Scholar
  • 29 Kiefer M, Eymann R, Steudel WI. Outcome predictors for normal-pressure hydrocephalus. Acta Neurochir Suppl 2006; 96: 364-7.
    PubMedSuche in Google Scholar
  • 30 Sand T, Bovim G, Grimse R, Myhr G, Helde G, Cappelen J. Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand 1994; 89 (Suppl. 05) 311-6.
    PubMedSuche in Google Scholar
  • 31 Savolainen S, Hurskainen H, Paljarvi L, Alafuzoff I, Vapalahti M. Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien) 2002; 144 (Suppl. 06) 515-23.
    CrossrefPubMedSuche in Google Scholar
  • 32 Vassilouthis J. Poor prognosis/good outcome in patients with NPH. J Neurosurg 2006; 104 (Suppl. 06) 986-8.
    CrossrefPubMedSuche in Google Scholar
  • 33 Delwel EJ, de Jong DA, Avezaat CJ. The prognostic value of clinical characteristics and parameters of cerebrospinal fluid hydrodynamics in shunting for idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2005; 147 (10) 1037-42.
    CrossrefPubMedSuche in Google Scholar
  • 34 Meier U, Lemcke J. Clinical outcome of patients with idiopathic normal pressure hydrocephalus three years after shunt implantation. Acta Neurochir Suppl 2006; 96: 377-80.
    PubMedSuche in Google Scholar
  • 35 Black PM. Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients. J Neurosurg 1980; 52 (Suppl. 03) 371-7.
    CrossrefPubMedSuche in Google Scholar
  • 36 Dixon GR, Friedman JA, Luetmer PH, Quast LM, McClelland RL, Petersen RC, Maher CO, Ebersold MJ. Use of cerebrospinal fluid flow rates measured by phase-contrast MR to predict outcome of ventriculoperitoneal shunting for idiopathic normal-pressure hydrocephalus. Mayo Clin Proc 2002; 77 (Suppl. 06) 509-14.
    CrossrefPubMedSuche in Google Scholar
  • 37 Kahlon B, Sundbarg G, Rehncrona S. Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002; 73 (Suppl. 06) 721-6.
    CrossrefPubMedSuche in Google Scholar
  • 38 Krauss JK, Regel JP. The predictive value of ventricular CSF removal in normal pressure hydrocephalus. Neurol Res 1997; 19 (Suppl. 04) 357-60.
    CrossrefPubMedSuche in Google Scholar
  • 39 Marmarou A, Black P, Bergsneider M, Klinge P, Relkin N. Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date. Acta Neurochir Suppl 2005; 95: 237-40.
    PubMedSuche in Google Scholar
  • 40 McConnell KA, Zou KH, Chabrerie AV, Bailey NO, Black PM. Decreases in ventricular volume correlate with decreases in ventricular pressure in idiopathic normal pressure hydrocephalus patients who experienced clinical improvement after implantation with adjustable valve shunts. Neurosurgery 2004; 55 (Suppl. 03) 582-92.
    CrossrefPubMedSuche in Google Scholar
  • 41 Meier U, Lemcke J, Al-Zain F. Course of disease in patients with idiopathic normal pressure hydrocephalus (iNPH): a follow-up study 3, 4 and 5 years following shunt implantation. Acta Neurochir Suppl 2008; 102: 125-7.
    PubMedSuche in Google Scholar
  • 42 Mori K. Management of idiopathic normal-pressure hydrocephalus: a multiinstitutional study conducted in Japan. J Neurosurg 2001; 95 (Suppl. 06) 970-3.
    CrossrefPubMedSuche in Google Scholar
  • 43 Walchenbach R, Geiger E, Thomeer RT, Vanneste JA. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002; 72 (Suppl. 04) 503-6.
    CrossrefPubMedSuche in Google Scholar
  • 44 Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery 2002; 51 (Suppl. 06) 1392-400.
    CrossrefPubMedSuche in Google Scholar
  • 45 Ishikawa M, Hashimoto M, Kuwana N, Mori E, Miyake H, Wachi A, Takeuchi T, Kazui H, Koyama H. Guidelines for management of idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo) 2008; 48 Suppl: S1-23.
    CrossrefPubMedSuche in Google Scholar