Download PDF
Nervenheilkunde 2017; 36(03): 173-176
DOI: 10.1055/s-0038-1635154
Übersichtsartikel
Schattauer GmbH

Evidenzbasierte Therapie des idiopathischen Normaldruckhydrozephalus

Evidence based therapy of the normal pressure hydrocephalus
J. Lemcke
1   Klinik für Neurochirurgie, Unfallkrankenhaus Berlin
,
S. Rot
1   Klinik für Neurochirurgie, Unfallkrankenhaus Berlin
,
U. Meier
1   Klinik für Neurochirurgie, Unfallkrankenhaus Berlin
› Author Affiliations
Further Information

Publication History

eingegangen am: 15 December 2016

angenommen am: 10 January 2017

Publication Date:
03 February 2018 (online)

    Permissions and Reprints

Zusammenfassung

Die klinische Forschung zum idiopathischen Normaldruckhydrozephalus erfolgt auf steigendem methodischem Niveau und ermöglicht die evidenzbasierte Therapie der Patienten. Die jährliche Inzidenz von Patienten mit einem diagnostizierten und therapierten idiopathischen Normaldruckhydrozephalus beträgt in den westlichen Ländern nach epidemiologischen Untersuchungen ca. 1/100 000 Einwohner. Non-invasive Methoden spielen in der Diagnostik eine zunehmend wichtigere Rolle, können allerdings die invasiven Methoden noch nicht ersetzen. Die grundsätzliche Effektivität von Liquorshunts zur Therapie des idiopathischen Normaldruckhydrozephalus konnte nachgewiesen werden. In weiteren Untersuchungen konnte gezeigt werden, dass die Komplikationsrate durch die Implantation von programmierbaren Ventilen mit Gravitationsventilen deutlich minimiert wird. Programmierbare Gravitationseinheiten wurden im Rahmen einer prospektiven Studie untersucht. Ihre Effektivität wird in einer prospektiv randomisierten Studie geprüft.

Summary

Due to the increasing methodical quality of clinical research on normal pressure hydrocephalus we are able to treat NPH patients evidence based. Epidemiological studies found an incidence of patients with normal pressure hydrocephalus in western countries of 1/100 000 inhabitants / year. Non-invasive diagnostics become more and more relevantly but are not able to replace invasive diagnostics yet. The effectiveness of cerebrospinal fluid shunts has been shown in a randomized controlled study (RCT). Another RCT showed that the complication rate of CSF shunts can be significantly lowered by the use of gravitational units. Safety of programmable gravitational units has been proven in a prospective cohort study. Currently, its effectiveness is examined in an RCT.

Schlüsselwörter

Idiopathischer Normaldruckhydrozephalus - evidenzbasierte Therapie - Anti-Siphon-Devices - programmierbare Gravitationseinheiten

Keywords

Idiopathic normal pressure hydrocephalus - evidence based therapy - anti siphon devices - programmable gravitational unit
 

  • Literatur

  • 1 Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965; 02 (04) 307-27.
    CrossrefPubMedGoogle Scholar
  • 2 Adams RD. et al. Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 1965; 273: 117-126.
    CrossrefPubMedGoogle Scholar
  • 3 Boon AJ. et al. Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of lowand medium-pressure shunts. J Neurosurg 1988; 88: 490-495.
    Google Scholar
  • 4 Marmarou A. et al. Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date. Acta Neurochir Suppl 2005; 95: 237-240.
    CrossrefPubMedGoogle Scholar
  • 5 Tisell M, Hoglund M, Wikkelso C. National and regional incidence of surgery for adult hydrocephalus in Sweden. Acta Neurol Scand 2005; 112: 72-75.
    Google Scholar
  • 6 Brean A, Eide PK. Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Acta Neurol Scand 2008; 118: 48-53.
    CrossrefPubMedGoogle Scholar
  • 7 Brean A. et al. Five-year incidence of surgery for idiopathic normal pressure hydrocephalus in Norway. Acta Neurol Scand 2009; 120: 314-316.
    CrossrefPubMedGoogle Scholar
  • 8 Lemcke J. et al. Nationwide incidence of normal pressure hydrocephalus (NPH) assessed by insurance claim data in Germany. Open Neurol J 2016; 10: 15-24.
    CrossrefPubMedGoogle Scholar
  • 9 Relkin N. et al. Diagnosing idiopathic normalpressure hydrocephalus. Neurosurgery 2005; 57: S4-16.
    CrossrefPubMedGoogle Scholar
  • 10 Evans WA. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry 1942; 931-937.
    Google Scholar
  • 11 Hashimoto M. et al. Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRIbased scheme: a prospective cohort study. Cerebrospinal Fluid Res 2010; 07: 18.
    CrossrefPubMedGoogle Scholar
  • 12 Craven CL. et al. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci 2016; 34: 294-298.
    CrossrefPubMedGoogle Scholar
  • 13 Wikkelso C. et al. The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2013; 84: 562-568.
    CrossrefPubMedGoogle Scholar
  • 14 Lenfeldt N. et al. Three-day CSF drainage barely reduces ventricular size in normal pressure hydrocephalus. Neurology 2012; 79: 237-242.
    CrossrefPubMedGoogle Scholar
  • 15 Esmonde T, Cooke S. Shunting for normal pressure hydrocephalus (NPH). Cochrane Database Syst. 2002 Rev: CD003157.
    PubMedGoogle Scholar
  • 16 udor KI, Tudor M, McCleery J, Car J. Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH). Cochrane Database Syst Rev. 2015 07. Cd010033.
    Google Scholar
  • 17 Gangemi M. et al. Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study. Neurosurgery 2008; 63: 62-67.
    CrossrefPubMedGoogle Scholar
  • 18 Kazui H, Miyajima M, Mori E, Ishikawa M. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an openlabel randomised trial. Lancet Neurol 2015; 14: 585-594.
    CrossrefPubMedGoogle Scholar
  • 19 Delwel EJ. et al. A randomised trial of high and low pressure level settings on an adjustable ventriculoperitoneal shunt valve for idiopathic normal pressure hydrocephalus: results of the Dutch evaluation programme Strata shunt (DEPSS) trial. J Neurol Neurosurg Psychiatry 2013; 84: 813-817.
    CrossrefPubMedGoogle Scholar
  • 20 Saehle T. et al. A randomized controlled dualcenter trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings. J Neurosurg 2014; 121: 1257-1263.
    CrossrefPubMedGoogle Scholar
  • 21 Farahmand D. et al. A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus. J Neurosurg 2015; 1-9.
    PubMedGoogle Scholar
  • 22 Meier U. et al. Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus. Neurosurgery 2013; 73: 1054-1060.
    CrossrefPubMedGoogle Scholar
  • 23 Lemcke J. et al. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry 2013; 84: 850-857.
    CrossrefPubMedGoogle Scholar
  • 24 Czosnyka Z. et al. Posture-related overdrainage: comparison of the performance of 10 hydrocephalus shunts in vitro. Neurosurgery 1998; 42: 327-333.
    CrossrefPubMedGoogle Scholar
  • 25 Kehler U. et al. PROSAIKA: a prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting. Clin Neurol Neurosurg 2015; 137: 132-136.
    CrossrefPubMedGoogle Scholar