Clinical neurology and neurosurgery · 2025
Optimal valve pressure for ventriculoatrial shunt in idiopathic normal pressure hydrocephalus: A retrospective study of 54 cases.
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Takagi Ryosuke, Takagi Kiyoshi, Asano Shuichiro, Nakamura Taishi, Ikegaya Naoki, Oshio Kotaro, Sakata Katsumi, Tateishi Kensuke, Yamamoto Tetsuya
Аннотация
BACKGROUND: In idiopathic normal pressure hydrocephalus (iNPH), optimal valve pressure selection is critical. While indicators have been reported for ventriculoperitoneal shunts (VPS) and lumboperitoneal shunts (LPS), no peer-reviewed publications have reported on ventriculoatrial shunts (VAS).
METHODS: We retrospectively analyzed 54 iNPH patients treated using a SPVA-140 valve without antisiphon device between 2010 and 2017. Clinical outcomes (modified Rankin scale, iNPH grading scale), valve pressures, and complications were assessed. Optimal pressure was defined as the setting associated with maximal improvement in iNPH grading scale, and its correlation with preoperative height, body weight, body mass index, and cerebrospinal fluid pressure was examined.
RESULTS: The median follow-up was 3.3 years. Optimal pressure was 10-40 mmH₂O in 81.5 % of patients (10 mmH₂O in 29, 40 mmH₂O in 15). Median improvements were 1 on the modified Rankin scale and 3 on the iNPH grading scale, with a median of 4 valve adjustments. Subdural hematoma occurred in 46.3 % of patients but was managed conservatively without requiring surgical intervention; shunt malfunction developed in 3 patients. No correlation was observed between optimal pressure and preoperative height, body weight, body mass index, or cerebrospinal fluid pressure.
CONCLUSION: Unlike VPS or LPS, optimal VAS pressure converges at low settings (10-40 mmH₂O) and is independent of body habitus. VAS may therefore be a particularly effective option in obese or elderly patients.
METHODS: We retrospectively analyzed 54 iNPH patients treated using a SPVA-140 valve without antisiphon device between 2010 and 2017. Clinical outcomes (modified Rankin scale, iNPH grading scale), valve pressures, and complications were assessed. Optimal pressure was defined as the setting associated with maximal improvement in iNPH grading scale, and its correlation with preoperative height, body weight, body mass index, and cerebrospinal fluid pressure was examined.
RESULTS: The median follow-up was 3.3 years. Optimal pressure was 10-40 mmH₂O in 81.5 % of patients (10 mmH₂O in 29, 40 mmH₂O in 15). Median improvements were 1 on the modified Rankin scale and 3 on the iNPH grading scale, with a median of 4 valve adjustments. Subdural hematoma occurred in 46.3 % of patients but was managed conservatively without requiring surgical intervention; shunt malfunction developed in 3 patients. No correlation was observed between optimal pressure and preoperative height, body weight, body mass index, or cerebrospinal fluid pressure.
CONCLUSION: Unlike VPS or LPS, optimal VAS pressure converges at low settings (10-40 mmH₂O) and is independent of body habitus. VAS may therefore be a particularly effective option in obese or elderly patients.