Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures
Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt impl...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.798488/full |
| _version_ | 1798033342881333248 |
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| author | Shigeki Yamada Shigeki Yamada Shigeki Yamada Masatsune Ishikawa Masatsune Ishikawa Madoka Nakajima Kazuhiko Nozaki |
| author_facet | Shigeki Yamada Shigeki Yamada Shigeki Yamada Masatsune Ishikawa Masatsune Ishikawa Madoka Nakajima Kazuhiko Nozaki |
| author_sort | Shigeki Yamada |
| collection | DOAJ |
| description | Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later. |
| first_indexed | 2024-04-11T20:28:52Z |
| format | Article |
| id | doaj.art-0d4e891770304a48b2a086fe44264fac |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T20:28:52Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-0d4e891770304a48b2a086fe44264fac2022-12-22T04:04:33ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-01-011210.3389/fneur.2021.798488798488Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and FailuresShigeki Yamada0Shigeki Yamada1Shigeki Yamada2Masatsune Ishikawa3Masatsune Ishikawa4Madoka Nakajima5Kazuhiko Nozaki6Department of Neurosurgery, Shiga University of Medical Science, Shiga, JapanInterfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, JapanDepartment of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, JapanDepartment of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, JapanRakuwa Villa Ilios, Rakuwakai Healthcare System, Kyoto, JapanDepartment of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, JapanDepartment of Neurosurgery, Shiga University of Medical Science, Shiga, JapanTreatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but ensuring optimal initial valve pressure is also important. Since over-drainage is most likely to occur in the month after shunting, it is generally believed that a high initial setting of shunt valve pressure is the safest option. However, this does not always result in sufficient improvement of the symptoms in the early period after shunting. In fact, evidence suggests that setting the optimal valve pressure early after shunting may cause symptoms to improve earlier. This leads to improved quality of life and better long-term independent living expectations. However, in iNPH patients, the remaining symptoms may worsen again after several years, even when there is initial improvement due to setting the optimal valve pressure early after shunting. Because of the possibility of insufficient CSF drainage, the valve pressure should be reduced by one step (2–4 cmH2O) after 6 months to a year after shunting to maximize symptom improvement. After the valve pressure is reduced, a head CT scan is advised a month later.https://www.frontiersin.org/articles/10.3389/fneur.2021.798488/fullidiopathic normal pressure hydrocephalus (iNPH)ventriculoperitoneal shunt (VP shunt)ventriclescerebrospinal fluid (CSF)pressure adjustment and managementCSF tap test |
| spellingShingle | Shigeki Yamada Shigeki Yamada Shigeki Yamada Masatsune Ishikawa Masatsune Ishikawa Madoka Nakajima Kazuhiko Nozaki Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures Frontiers in Neurology idiopathic normal pressure hydrocephalus (iNPH) ventriculoperitoneal shunt (VP shunt) ventricles cerebrospinal fluid (CSF) pressure adjustment and management CSF tap test |
| title | Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures |
| title_full | Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures |
| title_fullStr | Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures |
| title_full_unstemmed | Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures |
| title_short | Reconsidering Ventriculoperitoneal Shunt Surgery and Postoperative Shunt Valve Pressure Adjustment: Our Approaches Learned From Past Challenges and Failures |
| title_sort | reconsidering ventriculoperitoneal shunt surgery and postoperative shunt valve pressure adjustment our approaches learned from past challenges and failures |
| topic | idiopathic normal pressure hydrocephalus (iNPH) ventriculoperitoneal shunt (VP shunt) ventricles cerebrospinal fluid (CSF) pressure adjustment and management CSF tap test |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.798488/full |
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