Abstract Details

Title Lumbar Puncture Opening Pressure and Surgical Risk in NPH

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 260

Objective

Background BACKGROUND: The most common surgical complication in shunt surgery for NPH is over drainage. If surgeons could anticipate those at increased risk they may be able to take steps to decrease the risk.

Design/Methods DESIGN/METHODS: We evaluated by chart review 116 consecutive patients with idiopathic NPH shunted between 1/1/09 to 12/31/11 at Mayo Clinic Jacksonville. We documented the opening pressure and the complications after shunt surgery.

Results RESULTS: We shunted 118 patients, excluded 2 because they were shunted for secondary causes, 9 had history of head injury thought to be unlikely related to hydrocephalus and were included. Average f/up period was 18 months, and age 75.6 years. 41 % were female. 100% had gait difficulty, 75% urine difficulty and 64% memory loss. In 83% gait, 70% urine control and 44% memory improved after the surgery. All had CT scan 2-4 weeks post op to evaluate over drainage. 37/116 (32%) had over drainage on CT and 7 did not resolve with shunt valve pressure adjustment. The LP opening pressure (OP) was recorded in 105 patients and the median was 161 mm H2O. 14/53 (26%) below the median and 20/52 (38%) above the median had CT evidence of over drainage and all but 7 responded to shunt pressure adjustment. Interestingly, all 7 cases that did not respond were above the median.

Conclusions CONCLUSIONS: This study suggests that NPH patients undergoing shunt surgery with higher LP opening pressure above 161mm H2O may be at greater risk of over drainage complications. We caution that this is a small study and should be replicated. However if replicated surgeons may be able to decrease over drainage complications by setting the shunt valve opening pressure higher in those with higher LP opening pressures.

Authors/Disclosures
Quratulain S. Khan, MD, FAAN (Brigham and Womens Hospital) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
H. G. Deen, MD (Mayo Clinic Jacksonville)	No disclosure on file
	No disclosure on file
Sanjeet S. Grewal, MD	Sanjeet S. Grewal, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic.
Neill R. Graff-Radford, MD, FAAN (Mayo Clinic Jacksonville)	The institution of Dr. Graff-Radford has received research support from Biogen. The institution of Dr. Graff-Radford has received research support from Lilly. The institution of Dr. Graff-Radford has received research support from Eisai. The institution of Dr. Graff-Radford has received research support from Biogen. Dr. Graff-Radford has received publishing royalties from a publication relating to health care.

��ɫ��

��ɫ��