Article Text

other Versions

PDF
Research paper
A randomised trial of high and low pressure level settings on an adjustable ventriculoperitoneal shunt valve for idiopathic normal pressure hydrocephalus: results of the Dutch evaluation programme Strata shunt (DEPSS) trial
  1. Ernst J Delwel1,2,
  2. Dirk A de Jong1,
  3. Ruben Dammers1,3,
  4. Erkan Kurt4,5,
  5. Wimar van den Brink6,
  6. Clemens M F Dirven1
  1. 1Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Neurosurgery, Albert Schweitzer Hospital Dordrecht, Dordrecht, The Netherlands
  3. 3Department of Neurosurgery, Admiraal de Ruyter Hospital, Goes, The Netherlands
  4. 4Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Neurosurgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
  6. 6Department of Neurosurgery, Isala Clinics, Zwolle, The Netherlands
  1. Correspondence to
    Dr Ernst Jan Delwel, Department of Neurosurgery, Erasmus University Medical Centre, ‘s Gravendijkwal 230, Rotterdam 3000 CA, The Netherlands; e.j.delwel{at}erasmusmc.nl

Abstract

Background In treating idiopathic normal pressure hydrocephalus (INPH) with a shunt there is always a risk of underdrainage or overdrainage. The hypothesis is tested whether patients treated using an adjustable valve preset at the highest opening pressure leads to comparable good clinical results with less subdural effusions than in a control group with an opening pressure preset at a low pressure level.

Methods A multicentre prospective randomised trial was performed on a total of 58 patients suspected of INPH. Thirty patients were assigned to (control) group 1 and received a Strata shunt (Medtronic, Goleta, USA) with the valve preset at a performance level (PL) of 1.0, while 28 patients were assigned to group 2 and received a Strata shunt with the valve preset at PL 2.5. In this group the PL was allowed to be lowered until improvement or radiological signs of overdrainage were met.

Results Significantly more subdural effusions were observed in the improved patients of group 1. There was no statistically significant difference in improvement between both groups overall.

Conclusions On the basis of this multicentre prospective randomised trial it is to be recommended to treat patients with INPH with a shunt with an adjustable valve, preset at the highest opening pressure and lowered until clinical improvement or radiological signs of overdrainage occur although slower improvement and more shunt adjustments might be the consequence.

  • Csf Dynamics
  • Dementia
  • Gait
  • Geriatrics
  • Neurosurgery

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.