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  • Title: [Evaluation of shunt therapy in normal pressure hydrocephalus-surgical results in neurological conditions (author's transl)].
    Author: Tsuyumu M, Suganuma Y, Ohata M, Hiratsuka H, Inaba Y.
    Journal: No Shinkei Geka; 1976 Feb; 4(2):149-54. PubMed ID: 943721.
    Abstract:
    This presentation is a study of 18 patients diagnosed as having normal pressure hydrocephalus and treated by CSF diversion procedures. Pre- and postoperative neurological conditions of these patients were evaluated, compared, and analysed. There were 56% of males and 44% of females and the number of patients under 60 and over 61 were equal. The histories and clinical findings in all suggested a diagnosis of normal pressure hydrocephalus. In 12, the two thirds of patients, showed progressive intellectual deterioration, ataxic gait and/or incontinence following subarachnoid hemorrhage. Similar neurological features were preceded by craniocerebral trauma in one, megadolichobasilar artery in one and superior sagittal sinus thrombosis in one. Three cases were idiopathic. 169Yb cisternography, transfer test of radioisotope to blood, angiography and in some cases pneumoencephalography were performed in the usual manner to confirm the diagnosis. Attempts have been made to correlate the surgical results with the ages of patients, the duration of symtoms, and the causes of hydrocephalus. Neurological symptoms were divided into three groups. Group "A" is composed of mental deterioration, lack of spontaneity and willingness, mutism and disorientation, groups "B" includes gait disturbance and group "C" incontinence. The results of surgical treatment were analyzed according to the three groups of symptoms not only in the percentage of cases who improved but also in the time interval from the time of shunting to the appearance of operative results. The results are as follows. The good surgical improvements were achieved in the cases of under 70 years old, in the case of NPH of known causes, such as subarachnoid hemorrhage, craniocerebral trauma, and in the cases operated on within three months after the onset of symptoms. Recovery of "A" symtoms was achieved not only sooner after the operation but also in more cases than those of "B" and "C" symptoms. The correlation was analyzed between the duration or symptoms and time interval after the shunting and the appearance of operative results. Although no correlation was obtained in "A" symptoms, the sooner was shunting performed, the earlier appeared the operative results in "B" and "C" symptoms. In conclusion, it appeared from the results of the present study, that in addition to the integration of the results of different examinations such as isotope cisternography, air study and angiography, the combination of the patient data such as ages, duration of symptoms and the cause of hydrocephalus are essential in selecting the patients for shunting operation. If the diagnosis of normal pressure hydrocephalus is confirmed and surgical improvement is predicted, the patient should be shunted as soon as possible to obtain a good surgical results especially in mental symptoms, which is the important factor in performing rehabilitation therapy.
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