Normal pressure hydrocephalus: prognostic value of height in patients treated with an identical shunt system
Aguas J (1), Rodrigo V, Estupiñan F, Nogues P, Villalba G, Villagrasa J, Caral L.
(1) Servicio de Neurocirugía, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
Normal pressure hydrocephalus (NPH) is a clinical entity frequently managed by means of a cerebrospinal fluid shunt. Hydrodynamic hypotheses consider hydrostatic pressure (as well as height) a very important variable for shunt system function. However, we did not find empirical studies supporting the influence of height on clinical response in the literature. Our objective was to study the prognostic value of height, as a variable related to hydrostatic pressure, when an identical shunt system is used.
MATERIAL AND METHOD:
A prospective series of 61 idiopathic NPH cases was analyzed. All cases were shunted by means of a ventricle-peritoneal system with a 100mmH2O opening pressure valve. Anthropometric, clinical, radiological and pressure variables were registered, as well as delay for treatment, improvement and complications.
78.7% of cases improved after shunting. This group of patients was significantly taller (P=.005) than the group without response (median value 165cm versus 152cm). There was also a significant correlation between height and ventricular size decrease after the shunt.
In our series opening valve pressure was a constant (100mmHg) and we could consequently focus on the effect of hydrostatic pressure (height). Moreover, we found a positive predictive value for taller patients, probably because we had selected an opening pressure especially suitable for them. Current gravitational valve shunt systems also recommend considering patient height when customising the system. Our study empirically supports this idea.
CITATION Neurocirugia (Astur). 2013 May-Jun;24(3):102-9. doi: 10.1016/j.neucir.2013.01.005. Epub 2013 Mar 29