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İdiyopatik Normal Basınçlı Hidrosefali Tanısı ile Şant Uygulanan Hastaların Tedavi ve Gözlem Sonuçları

Year 2021, Volume: 11 Issue: 2, 388 - 394, 29.06.2021

Özgür Şenol Emine Dağıstan , Zeliha Coşgun , Melike Kalfaoglu Yasar Dagistan

https://doi.org/10.31832/smj.835351

Abstract

Amaç : İdiyopatik normal basınçlı hidrosefali (iNPH) tanısı ile orta basınçlı ventriküloperitoneal (VP) ve lumboperitoneal (LP) şant uygulanan hastaların 3 yıllık takip sırasında klinik sonuçları ve şant tedavisinde karşılaştığımız problemleri sunmayı amaçladık.
Gereç ve Yöntemler: Çalışmaya 2013 – 2017 tarihleri arasında Nöroloji ve Nöroşirurji Anabilim Dallarına başvuran, klinik ve radyolojik olarak iNPH olarak değerlendirilen hastalar retrospektif olarak tarandı.VP ve LP şant uygulanan hastalarda başarı oranları ve komplikasyonları kayıt edildi.
Bulgular: Değerlendirilen 26 hastanın 19 tanesine (%73,1) VP şant, 7 tanesine (%26,9) LP şant uygulandı. 6 hastaya (%23) batın revizyonu, 2 hastaya (%7,7) kraniyal revizyonu uygulandı. 6 hastaya (%23) batın revizyonu, 2 hastaya (%7,7) kraniyal revizyonu uygulandı. Cerrahi sonrası 1 hastada (%3) subdural hematom gelişti. 3 hastada (%11) valvin çalışmadığı gözlendi. 6 hastada (%23) şant oklüzyonu gelişti. 3 (%11) hastada analjezik tedaviye yanıtlı, günler içerisinde düzelen baş ağrısı gelişti. Hiçbir hastada şant enfeksiyonu, şant erezyonu, işitme kaybı, görme kaybı veya sistemik enfeksiyon gibi majör komplikasyon görülmedi.
Sonuç: iNBH’de hastaların yaş ortalaması yüksek olmasından dolayı beyin atrofiside eşlik edebileceğinden hızlı BOS boşalımının kanamalara sebep olma riski göz önünde bulundurulmalıdır. Komplikasyon oranının daha düşük olması ve ayarlanabilir şantın manyetik ortamlardan çabuk etkilenmesinden dolayı öncelikle orta basınçlı VP şant ve ardından LP şant düşünülebilir

Keywords

idiopatik normal basınçlı hidrosefali ventriküloperitoneal şant lumboperitoneal şant

References

  • 1. Martín-Láez R, Valle-San Román N, Rodríguez-Rodríguez E, Marco-de Lucas E, Blanco JB, Vázquez-Barquero A. Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease? Neurología (English Edition). 2018;33(7):449-58.
  • 2. Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371.
  • 3. Silverberg GD, Messier AA, Miller MC, Machan JT, Majmudar SS, Stopa EG, et al. Amyloid efflux transporter expression at the blood-brain barrier declines in normal aging. J Neuropathol Exp Neurol. 2010;69(10):1034-43.
  • 4. Silverberg GD, Miller MC, Messier AA, Majmudar S, Machan JT, Donahue JE, et al. Amyloid deposition and influx transporter expression at the blood-brain barrier increase in normal aging. J Neuropathol Exp Neurol. 2010;69(1):98-108.
  • 5. Tullberg M, Persson J, Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson Å. Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective—a cost utility analysis. Acta Neurochir (Wien). 2018;160(3):509-18.
  • 6. Graff-Radford NR, Jones DT. Normal pressure hydrocephalus. Continuum: Lifelong Learning in Neurology. 2019;25(1):165-86.
  • 7. Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson Å. Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus. J Neurosurg. 2014;121(4):776-84.
  • 8. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-4-S2-16.
  • 9. Parkkola R, Komu M, Kotilainen E, Valtonen S, Thomsen C, Gideon P. Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 2000;10(9):1442-6.
  • 10. Curran T, Lang AE. Parkinsonian syndromes associated with hydrocephalus: case reports, a review of the literature, and pathophysiological hypotheses. Movement disorders: official journal of the Movement Disorder Society. 1994;9(5):508-20.
  • 11. Bradley WG. Normal pressure hydrocephalus: new concepts on etiology and diagnosis. American Journal of Neuroradiology. 2000;21(9):1586-90.
  • 12. Krauss J, Regel J. The predictive value of ventricular CSF removal in normal pressure hydrocephalus. Neurol Res. 1997;19(4):357-60.
  • 13. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg. 1999;90(2):221-6.
  • 14. Bugalho P, Guimarães J. Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord. 2007;13(7):434-7.
  • 15. Picascia M, Zangaglia R, Bernini S, Minafra B, Sinforiani E, Pacchetti C. A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus. Funct Neurol. 2015;30(4):217.
  • 16. Savolainen S, Paljärvi L, Vapalahti M. Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir (Wien). 1999;141(8):849-53.
  • 17. Petersen RC, Mokri B, Laws ER. Surgical treatment of idiopathic hydrocephalus in elderly patients. Neurology. 1985;35(3):307-.
  • 18. Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nature Reviews Neurology. 2006;2(7):375.
  • 19. Andrew J, Nathan P. Lesions of the anterior frontal lobes and disturbances of micturition and defaecation. Brain. 1964;87(2):233-62.
  • 20. Larsson J, Israelsson H, Eklund A, Malm J. Epilepsy, headache, and abdominal pain after shunt surgery for idiopathic normal pressure hydrocephalus: the INPH-CRasH study. J Neurosurg. 2018;128(6):1674-83.
  • 21. Laws Jr ER, Mokri B. Occult hydrocephalus: Results of shunting correlated with diagnostic tests. Neurosurgery. 1977;24(CN_suppl_1):316-33.
  • 22. Hughes C, Siegel B, Coxe W, Gado M, Grubb R, Coleman R, et al. Adult idiopathic communicating hydrocephalus with and without shunting. J Neurol Neurosurg Psychiatry. 1978;41(11):961-71.
  • 23. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low-and medium-pressure shunts. J Neurosurg. 1998;88(3):490-5.
  • 24. Bergsneider M, Black PM, Klinge P, Marmarou A, Relkin N. Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-29-S2-39.
  • 25. Greenberg J, Shenkin H, Adam R. Idiopathic normal pressure hydrocephalus--a report of 73 patients. J Neurol Neurosurg Psychiatry. 1977;40(4):336-41.
  • 26. Malm J, Kristensen B, Stegmayr B, Fagerlund M, Koskinen L-O. Three-year survival and functional outcome of patients with idiopathic adult hydrocephalus syndrome. Neurology. 2000;55(4):576-8.
  • 27. Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-17-S2-28.
  • 28. Benzel EC, Pelletier AL, Levy PG. Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures. Neurosurgery. 1990;26(4):655-60.
  • 29. Krauss JK, Droste DW, Vach W, Jens P R, Orszagh M, Borremans JJ, et al. Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery. 1996;39(2):292-300.
  • 30. Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien). 2013;155(10):1977-80.
  • 31. Black P, Ojemann R, Tzouras A. CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg. 1985;32:632-51.
  • 32. Raftopoulos C, Massager N, Baleriaux D, Deleval J, Clarysse S, Brotchi J. Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery. 1996;38(1):51-9.
  • 33. Sainte-Rose C, Piatt J, Renier D, Pierre-Kahn A, Hirsch J, Hoffman H, et al. Mechanical complications in shunts. Pediatr Neurosurg. 1991;17(1):2-9.
  • 34. Schmidt K, Gjerris F, Osgaard O, Hvidberg EF, Kristiansen JE, Dahlerup B, et al. Antibiotic prophylaxis in cerebrospinal fluid shunting: a prospective randomized trial in 152 hydrocephalic patients. Neurosurgery. 1985;17(1):1-5.
  • 35. Haralampopoulos F, Iliadis H, Karniadakis S, Koutentakis D. Invasion of a peritoneal catheter into the inferior vena cava: report of a unique case. Surg Neurol. 1996;46(1):21-2.
  • 36.Lim HW, Shim BS, Yang CJ, Kim JH, Cho YH, Cho YS ve diğerleri (2014) Hidrosefali hastalarının iletişiminde ventriküloperitoneal şantı takiben işitme kaybı: bir pilot çalışma. Laringoskop 124: 1923–1927
  • 37. Miyazaki Y, Tomii M, Sawauchi S, Ikeuchi S, Yuki K, Abe T (1997) Ventrikülo-peritoneal şant prosedüründen sonra beyin omurilik sıvısının aşırı drenajının neden olduğu bir işitme kaybı vakası. Shinkei Geka yok 25: 367–371
  • 38. Stoeckli SJ, Bohmer A (1999) Hidrosefali için şant yerleştirildikten sonra kalıcı iki taraflı işitme kaybı. Vaka raporu. J Neurosurg 90: 773–775
  • 39. Shimizu S, Mochizuki T, Nakayama K, Fujii K. Visual field defects due to a shunt valve migrating into the cranium. Acta Neurochir (Wien). 2002;144(10):1055-6.
  • 40. Chung J-J, Yu J-S, Kim JH, Nam SJ, Kim M-J. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. American Journal of Roentgenology. 2009;193(5):1311-7.
  • 41. Kanai M, Kawano K, Uehara S. Upward migration of the LP shunt catheter into the cranial base. Osaka City Med J. 1999;45(2):123-7.
  • 42. Kariyattil R, Steinbok P, Singhal A, Cochrane DD. Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme. J Neurosurg Pediatr. 2007;106(5):350-3.

Year 2021, Volume: 11 Issue: 2, 388 - 394, 29.06.2021

Özgür Şenol Emine Dağıstan , Zeliha Coşgun , Melike Kalfaoglu Yasar Dagistan

https://doi.org/10.31832/smj.835351

Abstract

References

  • 1. Martín-Láez R, Valle-San Román N, Rodríguez-Rodríguez E, Marco-de Lucas E, Blanco JB, Vázquez-Barquero A. Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease? Neurología (English Edition). 2018;33(7):449-58.
  • 2. Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371.
  • 3. Silverberg GD, Messier AA, Miller MC, Machan JT, Majmudar SS, Stopa EG, et al. Amyloid efflux transporter expression at the blood-brain barrier declines in normal aging. J Neuropathol Exp Neurol. 2010;69(10):1034-43.
  • 4. Silverberg GD, Miller MC, Messier AA, Majmudar S, Machan JT, Donahue JE, et al. Amyloid deposition and influx transporter expression at the blood-brain barrier increase in normal aging. J Neuropathol Exp Neurol. 2010;69(1):98-108.
  • 5. Tullberg M, Persson J, Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson Å. Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective—a cost utility analysis. Acta Neurochir (Wien). 2018;160(3):509-18.
  • 6. Graff-Radford NR, Jones DT. Normal pressure hydrocephalus. Continuum: Lifelong Learning in Neurology. 2019;25(1):165-86.
  • 7. Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson Å. Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus. J Neurosurg. 2014;121(4):776-84.
  • 8. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-4-S2-16.
  • 9. Parkkola R, Komu M, Kotilainen E, Valtonen S, Thomsen C, Gideon P. Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 2000;10(9):1442-6.
  • 10. Curran T, Lang AE. Parkinsonian syndromes associated with hydrocephalus: case reports, a review of the literature, and pathophysiological hypotheses. Movement disorders: official journal of the Movement Disorder Society. 1994;9(5):508-20.
  • 11. Bradley WG. Normal pressure hydrocephalus: new concepts on etiology and diagnosis. American Journal of Neuroradiology. 2000;21(9):1586-90.
  • 12. Krauss J, Regel J. The predictive value of ventricular CSF removal in normal pressure hydrocephalus. Neurol Res. 1997;19(4):357-60.
  • 13. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg. 1999;90(2):221-6.
  • 14. Bugalho P, Guimarães J. Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord. 2007;13(7):434-7.
  • 15. Picascia M, Zangaglia R, Bernini S, Minafra B, Sinforiani E, Pacchetti C. A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus. Funct Neurol. 2015;30(4):217.
  • 16. Savolainen S, Paljärvi L, Vapalahti M. Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir (Wien). 1999;141(8):849-53.
  • 17. Petersen RC, Mokri B, Laws ER. Surgical treatment of idiopathic hydrocephalus in elderly patients. Neurology. 1985;35(3):307-.
  • 18. Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nature Reviews Neurology. 2006;2(7):375.
  • 19. Andrew J, Nathan P. Lesions of the anterior frontal lobes and disturbances of micturition and defaecation. Brain. 1964;87(2):233-62.
  • 20. Larsson J, Israelsson H, Eklund A, Malm J. Epilepsy, headache, and abdominal pain after shunt surgery for idiopathic normal pressure hydrocephalus: the INPH-CRasH study. J Neurosurg. 2018;128(6):1674-83.
  • 21. Laws Jr ER, Mokri B. Occult hydrocephalus: Results of shunting correlated with diagnostic tests. Neurosurgery. 1977;24(CN_suppl_1):316-33.
  • 22. Hughes C, Siegel B, Coxe W, Gado M, Grubb R, Coleman R, et al. Adult idiopathic communicating hydrocephalus with and without shunting. J Neurol Neurosurg Psychiatry. 1978;41(11):961-71.
  • 23. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low-and medium-pressure shunts. J Neurosurg. 1998;88(3):490-5.
  • 24. Bergsneider M, Black PM, Klinge P, Marmarou A, Relkin N. Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-29-S2-39.
  • 25. Greenberg J, Shenkin H, Adam R. Idiopathic normal pressure hydrocephalus--a report of 73 patients. J Neurol Neurosurg Psychiatry. 1977;40(4):336-41.
  • 26. Malm J, Kristensen B, Stegmayr B, Fagerlund M, Koskinen L-O. Three-year survival and functional outcome of patients with idiopathic adult hydrocephalus syndrome. Neurology. 2000;55(4):576-8.
  • 27. Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(suppl_3):S2-17-S2-28.
  • 28. Benzel EC, Pelletier AL, Levy PG. Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures. Neurosurgery. 1990;26(4):655-60.
  • 29. Krauss JK, Droste DW, Vach W, Jens P R, Orszagh M, Borremans JJ, et al. Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery. 1996;39(2):292-300.
  • 30. Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien). 2013;155(10):1977-80.
  • 31. Black P, Ojemann R, Tzouras A. CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg. 1985;32:632-51.
  • 32. Raftopoulos C, Massager N, Baleriaux D, Deleval J, Clarysse S, Brotchi J. Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery. 1996;38(1):51-9.
  • 33. Sainte-Rose C, Piatt J, Renier D, Pierre-Kahn A, Hirsch J, Hoffman H, et al. Mechanical complications in shunts. Pediatr Neurosurg. 1991;17(1):2-9.
  • 34. Schmidt K, Gjerris F, Osgaard O, Hvidberg EF, Kristiansen JE, Dahlerup B, et al. Antibiotic prophylaxis in cerebrospinal fluid shunting: a prospective randomized trial in 152 hydrocephalic patients. Neurosurgery. 1985;17(1):1-5.
  • 35. Haralampopoulos F, Iliadis H, Karniadakis S, Koutentakis D. Invasion of a peritoneal catheter into the inferior vena cava: report of a unique case. Surg Neurol. 1996;46(1):21-2.
  • 36.Lim HW, Shim BS, Yang CJ, Kim JH, Cho YH, Cho YS ve diğerleri (2014) Hidrosefali hastalarının iletişiminde ventriküloperitoneal şantı takiben işitme kaybı: bir pilot çalışma. Laringoskop 124: 1923–1927
  • 37. Miyazaki Y, Tomii M, Sawauchi S, Ikeuchi S, Yuki K, Abe T (1997) Ventrikülo-peritoneal şant prosedüründen sonra beyin omurilik sıvısının aşırı drenajının neden olduğu bir işitme kaybı vakası. Shinkei Geka yok 25: 367–371
  • 38. Stoeckli SJ, Bohmer A (1999) Hidrosefali için şant yerleştirildikten sonra kalıcı iki taraflı işitme kaybı. Vaka raporu. J Neurosurg 90: 773–775
  • 39. Shimizu S, Mochizuki T, Nakayama K, Fujii K. Visual field defects due to a shunt valve migrating into the cranium. Acta Neurochir (Wien). 2002;144(10):1055-6.
  • 40. Chung J-J, Yu J-S, Kim JH, Nam SJ, Kim M-J. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. American Journal of Roentgenology. 2009;193(5):1311-7.
  • 41. Kanai M, Kawano K, Uehara S. Upward migration of the LP shunt catheter into the cranial base. Osaka City Med J. 1999;45(2):123-7.
  • 42. Kariyattil R, Steinbok P, Singhal A, Cochrane DD. Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme. J Neurosurg Pediatr. 2007;106(5):350-3.
There are 42 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Özgür Şenol This is me 0000-0002-4106-5666

Emine Dağıstan 0000-0002-0202-8555

Zeliha Coşgun 0000-0003-1996-1568

Melike Kalfaoglu This is me 0000-0003-1678-763X

Yasar Dagistan 0000-0002-1668-7850

Publication Date June 29, 2021
Submission Date December 11, 2020
Published in Issue Year 2021 Volume: 11 Issue: 2

Cite

AMA Şenol Ö, Dağıstan E, Coşgun Z, Kalfaoglu M, Dagistan Y. İdiyopatik Normal Basınçlı Hidrosefali Tanısı ile Şant Uygulanan Hastaların Tedavi ve Gözlem Sonuçları. Sakarya Tıp Dergisi. June 2021;11(2):388-394. doi:10.31832/smj.835351

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