Treatment Strategies Of Idiopathic Normal Pressure Hydrocephalus

Objective: Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndromecharacterized clinically by gait impairment, dementia, and urinary incontinence with theexpansion of the ventricular system. This disease is more common in older people andcause unknown. Symptoms in some patients can be improved by the shunt. This studyexplores surgical indications, prognosis and prevention of complications by thediagnosis and treatment of idiopathic normal pressure hydrocephalus disease to guideclinical treatment.Methods:59patients of idiopathic normal pressure hydrocephalus from January2009to January2014were reviewed. All the patients were examined by head CT/MRI.Before surgery, All patients were underwent cerebrospinal fluid tap test (CSF-tt) asremoving30ml CSF and underwent external lumbar drainage (ELD)48hours later.Assessment of the patient’s symptoms was at1h before the test and24h after the test.All the patients were treated by ventricular-peritoneal shunt. We assessed neurologicalfunction in patients at7days after the surgery and asked two families to participate.Through the patient’s head CT/MRI, improvement of patients ’clinical symptoms aftercerebrospinal fluid tap test, improvement of patients’ clinical symptoms after externallumbar drainage and duration of disease with effect after shunt, we predict the efficacyof surgery.Results:2patients with intracranial infection lead to treatment failure, the wholeexperiment is not completed.46of the57(80.7%) shunted patients had improved.3months after surgery, valve malfunction occurred in3patients, excessive drainage occurred in1patient. Among the41patients with interstitial cerebral edema on head CT/MRI,37patients (90.2%) had improved (P<0.05). Among the39patients withimprovement of clinical symptoms after cerebrospinal fluid tap test,35patients (89.7%)had improved (P<0.05). Among the48patients with improvement of clinical symptomsafter external lumbar drainage,44patients (91.7%) had improved (P<0.05). Among the31patients’course less than six months,29patients (95.5%) had improved (P<0.05).Conclusion: The study suggests that patients with interstitial cerebral edema on headCT/MRI, patients with improvement of clinical symptoms after cerebrospinal fluid taptest, patients with improvement of clinical symptoms after external lumbar drainage andpatients’ course less than six months recommend early ventricle-peritoneal shunt. Whileprevent complications effectively, surgical results are better. On the other hand, patientsof idiopathic normal pressure hydrocephalus need to be treated with caution, werecommend follow-up.