Natural history of ventriculomegaly in adults: a cluster analysis

Craven, Claudia; Ramkumar, Roshini; D’Antona, Linda; Thompson, Simon D; Thorne, Lewis; Watkins, Laurence; Toma, Ahmed K

doi:10.3171/2018.8.jns18119

Cited by 14 publications

(22 citation statements)

References 16 publications

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“…In our series, the overall median age of patients at the time of diagnosis was 64 (IQR: 54.5–74), whereas the median age of patients treated with ETV or with VPS at first was 59 (IQR: 52.5–67) and 66.5 (IQR: 61–76), respectively. These data are similar to previous studies [ 2 , 22 , 23 , 24 ] which reported a lower age in patients treated with ETV, probably due to the attitude to avoid a shunt dependency in younger patients. Al-Jumaily et al [ 5 ] and Ved and al.…”

Section: Discussionsupporting

confidence: 92%

“…Although VPS appears to improve NPH-like symptoms earlier in the first postoperative period compared to ETV, this difference in clinical outcome is lost at last follow-up. In accordance with the literature [ 1 , 2 , 6 , 8 , 14 , 22 , 24 , 25 ], although ETV seems to be preferred in term of lower surgical complications compared to VPS with similar clinical outcome, ETV required a conversion to VPS and a second surgery in 26.7% of our patients. Similarly, Al-Jumaily et al [ 5 ] reported that ETV was successful in controlling symptoms in 89% of patients with three patients (15%) requiring shunts (gravitational valves).…”

Section: Discussionsupporting

confidence: 90%

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Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

Montemurro

Indaimo

Carlo

et al. 2022

IJERPH

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Background: Long-standing overt ventriculomegaly in adults (LOVA) is an uncommon type of adult chronic hydrocephalus. In recent years, conflicting case series described different outcomes after treatment of LOVA with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS). The aim of this study is to report a single institutional surgical experience of patients with LOVA in order to evaluate the clinical outcome of those patients treated with one or, sometimes, both surgical procedures, analyzing the main clinical features of these patients, before and after surgery. Methods: We conducted a retrospective study on 31 patients with diagnosis of LOVA, who were treated in our University Hospital between December 2010 and October 2020. We reported gender, age, clinical presentation, surgical treatment, and clinical outcome according to the Kiefer index (KI). Evans’ index, head circumference, aqueductal stenosis and expanded/destroyed sella turcica were assessed on preoperative MRI. Results: The most common clinical manifestation was gait disturbances (100%) followed by urinary incontinence in 23 (74.2%) patients and cognitive deficits in 22 (71%) patients. On preoperative MRI, the overall mean Evans’s Index was 0.49, whereas the overall mean head circumference was 57.3 cm. Twenty-three patients (74.2%) had obliterated cortical sulci, 20 (64.5%) patients had aqueductal stenosis, and 22 (71%) patients had an expanded/destroyed sella turcica on preoperative MRI. Fifteen (48.4%) patients underwent ETV and sixteen (51.6%) were treated with VPS as first surgical procedure. Four (26.6%) out of fifteen patients treated with ETV required a subsequent VPS. The overall median age of patients was 64 (IQR: 54.5–74) and the overall median follow-up was 57 months (IQR 21.5–81.5). Overall morbidity was 22.5%. Mean recovery index (RI), according to KI, was 3.8 ± 4.3 and 2.2 ± 5.6 (p = 0.05) at last follow-up in patients treated with ETV and VPS, respectively. Conclusions: The choice of surgical treatment of LOVA remains under discussion. Although EVT is a tempting option for patients with LOVA, conversion to VP shunt is not uncommon.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

Montemurro

Indaimo

Carlo

et al. 2022

IJERPH

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“…In four cases, although MRI showed a static ventricular size, shunt revision surgery was done in view of worsening of symptoms clinically. There is constraints in diagnosis of acute components of hydrocephalus in chronically shunt treated patients with severe ventricular dilation (11). Non-surgical management was predicted accurately in 64 out of the 67cases managed conservatively by medical management.…”

Section: Resultsmentioning

confidence: 98%

To Study the Role of Limited Sequence Magnetic Resonance Imaging in Assessment of Children With Hydrocephalus.

Subramanian

Rajeshkannan

Moorthy

et al. 2021

IJAR

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Aim: To evaluate the role of limited sequence MRI (LS MRI) in diagnosing obstructive from nonobstructive hydrocephalus for treatment planning correlating with surgical findings and in follow up cases of shunt treated hydrocephalus to predict the candidate requires revision surgery correlating with final treatment. Materials and Methods: A total of 235 cases were included in the study underwent limited sequence MRI, 121 cases were evaluated for diagnosing obstructive from nonobstructive hydrocephalus out of which 106 cases underwent surgery were correlated with surgical findings and 114 were symptomatic follow up cases evaluated for need of revision surgery. Diagnostic measures such as sensitivity, specificity, PPV, NPV and accuracy were calculated. A p value of <0.05 was considered to be statistically significant. Results: Obstruction was seen in 81 out of the 106 cases who underwent surgery. MRI showed obstruction in 72(88.9%) and no obstruction in 9(11.1%) cases. Out of the 25 cases with no obstruction in surgery, MRI correctly excluded obstruction in 20(80%) cases. MRI misdiagnosed obstruction in 5(20%) cases. No statistically significant difference between the limited sequence MRI and surgery (p value of 0.424 Sensitivity 88.89%, Specificity 80% PPV 93.51%, NPV 68.97% and Accuracy 86.79%). Out of the total 114 follow up cases of hydrocephalus,47 underwent surgery and 67 cases were managed conservatively. MRI criteria predicted surgical candidate in 43(91.5%) and no surgery in 4(8.5%) patients. MRI criteria predicted nonsurgical management in 64 (95.5%) out of the 67 cases and the rest of 3 (4.5%) cases MRI over rated need for surgery. (Sensitivity:91.49% Specificity:95.52% PPV: 93.5% NPV 94.1% Accuracy :93.9%.) Conclusion: LS MRI has good accuracy in detecting an obstruction in paediatric hydrocephalus. In predicting revision surgery for follow-up cases of shunt-treated hydrocephalus, LS MRI has good accuracy.

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“…These patients can be identified by a tap test from the VP shunt, and at time of data collection was managed with exploration of the shunt and if patent, explantation of the shunt valves and replacement with an adjustable antigravity valve. It is particularly important to differentiate these patients from those with NPH-like longstanding overt ventriculomegaly (LOVA), who may also not respond to CSF diversion in the same way as NPH, and who will significantly overdrain with further CSF drainage [3].…”

Section: An Emerging Option In Management Of Complex Nph?mentioning

confidence: 99%

Ultra-low-pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable antigravity valves

et al. 2020

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BackgroundIdiopathic Normal Pressure Hydrocephalus (NPH) is a condition of the elderly treated by ventriculoperitoneal shunt (VP) insertion. A subset of NPH patients respond only temporarily to shunt insertion despite low valve opening pressure. This study aims to describe our experience of patients who benefit from further CSF drainage by adding adjustable anti-gravity valves and draining CSF at ultra-low pressure. MethodsSingle-centre retrospective case series of patients undergoing shunt valve revision from an adjustable differential pressure valve with fixed antigravity unit to a system incorporating an adjustable gravitational valve (Miethke proSA). Patients were screened from a database of NPH patients undergoing CSF diversion over 10 consecutive years (April 2008 -April 2018. Clinical records were retrospectively reviewed for interventions and clinical outcomes. ResultsNineteen (10F:9M) patients underwent elective VP shunt revision to a system incorporating an adjustable gravitational valve. Mean age 77.1  7.1 years (mean  SD).Eleven patients (58%) showed significant improvement in walking speed following shunt revision. Fourteen patients/carers (74%) reported subjective improvements in symptoms following shunt revision. ConclusionsPatients presenting symptoms relapse following VP shunting may represent a group of patients with ultra-lowpressure hydrocephalus, for whom further CSF drainage may lead to improvement in symptoms. These cases may benefit from shunt revision with an adjustable gravitational valve, adjustment of which can lead to controlled siphoning of CSF and drain CSF despite ultra-low CSF pressure.

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Natural history of ventriculomegaly in adults: a cluster analysis

Cited by 14 publications

References 16 publications

Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

To Study the Role of Limited Sequence Magnetic Resonance Imaging in Assessment of Children With Hydrocephalus.

Ultra-low-pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable antigravity valves

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