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Lumboperitoneal shunt in an outpatient setting for the treatment of chronic hydrocephalus in adults. A study and follow-up of 30 cases

C. Barcia-Mariño, L.G. González-Bonet, L. Salvador-Gozalbo, F. Goig-Revert, R. Rodríguez-Mena [REV NEUROL 2009;49:300-306] PMID: 19728276 DOI: https://doi.org/10.33588/rn.4906.2008618

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Volumen 49 | Number 06 | Nº of views of the article 10.683 | Nº of PDF downloads 638 | Article publication date 15/09/2009

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ABSTRACT

INTRODUCTION AND AIMS. One of the therapeutic options for chronic adult hydrocephalus that has become widely used in our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on the first 30 patients treated in this way with a follow-up of between one and five years.

PATIENTS AND METHODS Diagnosis was reached after studying the patient history and a clinical examination; Hakim and Adams’ triad was found to be a primary and highly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients who responded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic and sedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale (Rankin-Stein and Langfitt-Vall d’Hebron) and graphic tests based on the minimental test.

RESULTS At three months, 21 patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have been monitored for four and five years. Five patients died due to intercurrent illnesses.

CONCLUSIONS After comparing the complications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discuss the usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, where the complications are more severe because they invade the brain and due to the need for general anaesthesia and longer hospitalisation. In addition, the method is more economical than the alternatives. KeywordsAmbulatory treatment Chronic adult hydrocephalus Dementia Hakim-Adams syndrome Hydrocephalus Lumboperitoneal shunt CategoriesDemencia

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Original

Lumboperitoneal shunt in an outpatient setting for the treatment of chronic hydrocephalus in adults. A study and follow-up of 30 cases