Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series

Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series

Introduction: Normal Pressure Hydrocephalus (NPH) is a prevalent neuropsychiatric disorder characterized by Hakim’s triad: Dementia, gait disturbance, and urinary incontinence in the setting of ventriculomegaly. Ventriculoperitoneal (VP) shunting is largely considered the definitive therapy for NPH....

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Autores principales: Vivian Hagerty, Christopher Galvin, Amrika Maharaj, Frank Vrionis
Formato: article
Lenguaje:EN
Publicado: Elsevier 2022
Materias:
Neurosurgery
Normal pressure hydrocephalus
Ventriculoatrial shunt
Revision
Obesity
Surgery
RD1-811
Neurology. Diseases of the nervous system
RC346-429
Acceso en línea:https://doaj.org/article/100d8dc4c5cf44168f12c5032eb847aa
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spelling oai:doaj.org-article:100d8dc4c5cf44168f12c5032eb847aa2021-11-20T05:06:29ZVentriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series2214-751910.1016/j.inat.2021.101433https://doaj.org/article/100d8dc4c5cf44168f12c5032eb847aa2022-03-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214751921003455https://doaj.org/toc/2214-7519Introduction: Normal Pressure Hydrocephalus (NPH) is a prevalent neuropsychiatric disorder characterized by Hakim’s triad: Dementia, gait disturbance, and urinary incontinence in the setting of ventriculomegaly. Ventriculoperitoneal (VP) shunting is largely considered the definitive therapy for NPH. A significant limitation with VP shunts is their rate of failure, which is especially evident in the setting of increased intra-abdominal pressure (IAP). Methods: We retrospectively analyzed the successful placement of ventriculoatrial (VA) shunts in two patients with NPH and increased IAP secondary to high BMI. We assessed outcomes based on improvements in fluency and mentation, patient-reported decreases in urinary frequency, and Tinetti-test assessments for gait. Results: Both patients presented with short term memory loss, urinary incontinence, and shuffling gaits. Lumbar punctures performed in the hospital improved their symptoms, and VP shunts were placed with no improvement in gait or cognition. As both patients had high BMIs, we felt the shunts were not performing optimally due to high intraabdominal pressures and converted the VP shunts to VA shunts. This intervention finally provided long-lasting symptom relief at six- and ten-month follow-up, respectively. Conclusions: The diversion of fluid performed by shunt therapy for NPH is dependent on a distal pressure lower than the patient’s intraventricular pressure. Overweight and obese patients may have elevated IAP of great clinical significance for VP shunt placement, and this variable merits consideration when neurosurgeons select which distal cavity is most appropriate for their NPH patients.Vivian HagertyChristopher GalvinAmrika MaharajFrank VrionisElsevierarticleNeurosurgeryNormal pressure hydrocephalusVentriculoatrial shuntRevisionObesitySurgeryRD1-811Neurology. Diseases of the nervous systemRC346-429ENInterdisciplinary Neurosurgery, Vol 27, Iss , Pp 101433- (2022)
institution DOAJ
collection DOAJ
language EN
topic Neurosurgery
Normal pressure hydrocephalus
Ventriculoatrial shunt
Revision
Obesity
Surgery
RD1-811
Neurology. Diseases of the nervous system
RC346-429
spellingShingle Neurosurgery
Normal pressure hydrocephalus
Ventriculoatrial shunt
Revision
Obesity
Surgery
RD1-811
Neurology. Diseases of the nervous system
RC346-429
Vivian Hagerty
Christopher Galvin
Amrika Maharaj
Frank Vrionis
Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
description Introduction: Normal Pressure Hydrocephalus (NPH) is a prevalent neuropsychiatric disorder characterized by Hakim’s triad: Dementia, gait disturbance, and urinary incontinence in the setting of ventriculomegaly. Ventriculoperitoneal (VP) shunting is largely considered the definitive therapy for NPH. A significant limitation with VP shunts is their rate of failure, which is especially evident in the setting of increased intra-abdominal pressure (IAP). Methods: We retrospectively analyzed the successful placement of ventriculoatrial (VA) shunts in two patients with NPH and increased IAP secondary to high BMI. We assessed outcomes based on improvements in fluency and mentation, patient-reported decreases in urinary frequency, and Tinetti-test assessments for gait. Results: Both patients presented with short term memory loss, urinary incontinence, and shuffling gaits. Lumbar punctures performed in the hospital improved their symptoms, and VP shunts were placed with no improvement in gait or cognition. As both patients had high BMIs, we felt the shunts were not performing optimally due to high intraabdominal pressures and converted the VP shunts to VA shunts. This intervention finally provided long-lasting symptom relief at six- and ten-month follow-up, respectively. Conclusions: The diversion of fluid performed by shunt therapy for NPH is dependent on a distal pressure lower than the patient’s intraventricular pressure. Overweight and obese patients may have elevated IAP of great clinical significance for VP shunt placement, and this variable merits consideration when neurosurgeons select which distal cavity is most appropriate for their NPH patients.
format article
author Vivian Hagerty
Christopher Galvin
Amrika Maharaj
Frank Vrionis
author_facet Vivian Hagerty
Christopher Galvin
Amrika Maharaj
Frank Vrionis
author_sort Vivian Hagerty
title Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
title_short Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
title_full Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
title_fullStr Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
title_full_unstemmed Ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: A Case series
title_sort ventriculoatrial shunts as an alternate therapy in patients with normal pressure hydrocephalus refractory to ventriculoperitoneal shunts: a case series
publisher Elsevier
publishDate 2022
url https://doaj.org/article/100d8dc4c5cf44168f12c5032eb847aa
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AT christophergalvin ventriculoatrialshuntsasanalternatetherapyinpatientswithnormalpressurehydrocephalusrefractorytoventriculoperitonealshuntsacaseseries
AT amrikamaharaj ventriculoatrialshuntsasanalternatetherapyinpatientswithnormalpressurehydrocephalusrefractorytoventriculoperitonealshuntsacaseseries
AT frankvrionis ventriculoatrialshuntsasanalternatetherapyinpatientswithnormalpressurehydrocephalusrefractorytoventriculoperitonealshuntsacaseseries
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