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Published on: October 2, 2014
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An Interdisciplinary Protocol for Ventriculoperitoneal Shunt Patient Selection in Normal Pressure Hydrocephalus.
Kyle McGrath1, Dimitri Laurent2, Oriana Otero2
1College of Medicine, University of Florida, Gainesville, Florida, USA.
World Neurosurgery
|April 28, 2024
Summary
A new protocol using gait, balance, and cognition tests helps identify normal pressure hydrocephalus patients who benefit from ventriculoperitoneal shunt (VPS) placement. However, symptom recurrence is common one year post-surgery.
Area of Science:
- Neurology
- Neurosurgery
- Physical Medicine and Rehabilitation
Background:
- Normal pressure hydrocephalus (NPH) treatment lacks standardized indications for ventriculoperitoneal shunt (VPS) placement.
- Current NPH management often relies on subjective assessments, leading to variable treatment outcomes.
Purpose of the Study:
- To establish a reliable protocol for identifying NPH patients who will benefit from VPS.
- To evaluate the efficacy and safety of a standardized assessment protocol for VPS candidacy.
Main Methods:
- Developed a protocol involving physical and occupational therapists administering validated tests of gait, balance, and cognition.
- Assessed patients before and after lumbar drain placement using tests like Timed "Up & Go" and Mini Mental Status Exam.
- Conducted a retrospective review of patients treated under this protocol, analyzing VPS candidacy and symptomatic improvement.
Main Results:
- 64% of patients received VPS, with 89.6% reporting initial symptom improvement.
- Significant improvement in Tinetti scores was observed in patients who benefited from VPS compared to the control group.
- 18% experienced subdural fluid collections, and 6% had other complications post-surgery.
Conclusions:
- Standardized pre- and post-cerebrospinal fluid diversion assessments effectively identify NPH patients likely to benefit from VPS.
- The protocol demonstrates a low complication rate, but symptom recurrence affects approximately half of patients within one year.
Keywords:
Neuropsychological testingNormal pressure hydrocephalusOccupational therapyPhysical therapyRehabilitationMore Related Videos
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