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Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

  • Oral presentation
  • Open Access

One-year outcome in patients with idiopathic normal-pressure hydrocephalus treated with a lumbo-peritoneal shunt (SINPHONI-2), compared to ventriculo-peritoneal shunt (SINPHONI) used as a historical control

  • 1Email author,
  • 2,
  • 3 and
  • 4
Fluids and Barriers of the CNS201512 (Suppl 1) :O46

https://doi.org/10.1186/2045-8118-12-S1-O46

  • Published:

Keywords

  • Hydrocephalus
  • Subarachnoid Space
  • Historical Control
  • Modify Rankin Scale
  • Normal Pressure Hydrocephalus

Introduction

Idiopathic normal pressure hydrocephalus (INPH) is treated with cerebrospinal fluid shunting, and ventriculo-peritoneal shunt (VPS) is the current standard treatment. The goal of this pooled analysis was to compare the efficacy and safety between VPS and lumbo-peritoneal shunt (LPS) in patients with INPH specified as disproportionately enlarged subarachnoid space hydrocephalus (DESH).

Methods

We conducted a multicenter prospective 3-month randomized controlled trial, and then a 1-year extension study, where all subjects received an LPS with a programmable valve and were examined periodically for 1 year. Eighty-three patients with INPH (60 to 85 years old) presenting with ventriculomegaly, high-convexity and medial subarachnoid space tightness in magnetic resonance imaging were recruited from 20 neurological or neurosurgical centers in Japan between March 1, 2010 and October 19, 2011. The primary outcome was the modified Rankin scale (mRS) score 1 year after surgery, and secondary outcome included the NPH grading scale (NPHGS). The VPS SINPHONI study was used as a historical control.

Results

The proportion of patients with a favorable outcome (i.e., improvement of at least one level in mRS) was 63% (95% CI: 51-73%), and was comparable to that with VPS implantation (69%, 95% CI: 59-78%). In NPHGS, the one-year improvement rate was 75% (95% CI: 64-84%) and was comparable to that of VPS (77%, 95% CI: 68-84%). Serious adverse events (SAEs) occurred in 19 patients (22%), 10 of which were related to surgery. SAEs were more common with LPS than with VPS (15%).

Conclusion

Our results show that LPSs with programmable valves are effective for treating INPH as an alternative to VPSs.

Authors’ Affiliations

(1)
Department of Neurosurgery, Juntendo University Graduate School of Medicine, Japan
(2)
Department of Psychiatry, Osaka University Graduate School of Medicine, Japan
(3)
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Japan
(4)
Normal-Pressure Hydrocephalus Centre, Otowa Hospital, Japan

References

  1. Miyajima M, Nakajima M, Ogino I, Miyata H, Motoi Y, Arai H: Soluble amyloid precursor protein α in the cerebrospinal fluid as a diagnostic and prognostic biomarker for idiopathic normal pressure hydrocephalus. Eur J Neurol. 2013, 20 (2): 236-242. 10.1111/j.1468-1331.2012.03781.x.View ArticlePubMedGoogle Scholar
  2. Watanabe M, Miyajima M, Ogino I, Nakajima M, Arai H: Cerebellar Purkinje Cells Exhibit Increased Expression of HMGB-1 and Apoptosis in Congenital Hydrocephalic H-Tx Rats. Neurosurgery. 2013, 72 (3): 459-467. 10.1227/NEU.0b013e31827fcd83.View ArticlePubMedGoogle Scholar
  3. Miyajima M, Nakajima M, Motoi Y, Moriya M, Sugano H, Ogino I, Nakamura E, Tada N, Kunichika M, Arai H: Leucine-rich α2-glycoprotein is a novel biomarker of neurodegenerative disease in human cerebrospinal fluid and causes neurodegeneration in mouse cerebral cortex. PLoS One. 2013, 8 (9): e74453-10.1371/journal.pone.0074453.PubMed CentralView ArticlePubMedGoogle Scholar
  4. Hoshi K, Kariya Y, Nara K, Ito H, Matsumoto K, Nagae M, Yamaguchi Y, Nakajima M, Miyajima M, Arai H, Kuno A, Narimatsu H, Shirotani K, Hashimoto Y: Lectin-dependent inhibition of antigen-antibody reaction: application for measuring α2,6-sialylated glycoforms of transferrin. J Biochem. 2013, 154 (3): 229-32. 10.1093/jb/mvt065.View ArticlePubMedGoogle Scholar
  5. Tsutsumi S, Ogino I, Miyajima M, Ikeda T, Shindo N, Yasumoto Y, Ito M, Arai H: Genomic causes of multiple cerebral cavernous malformations in a Japanese population. J Clin Neurosci. 2013, 20 (5): 667-9. 10.1016/j.jocn.2012.05.041.View ArticlePubMedGoogle Scholar
  6. Shimoji K, Kimura T, Kondo A, Tange Y, Miyajima M, Arai H: Genetic studies of myelomeningocele. Childs Nerv Syst. 2013, 29 (9): 1417-25. 10.1007/s00381-013-2197-2.View ArticlePubMedGoogle Scholar
  7. Nakanishi A, Fukunaga I, Hori M, Masutani Y, Takaaki H, Miyajima M, Aoki S: Microstructural changes of the corticospinal tract in idiopathic normal pressure hydrocephalus: a comparison of diffusion tensor and diffusional kurtosis imaging. Neuroradiology. 2013, 55 (8): 971-6. 10.1007/s00234-013-1201-6.View ArticlePubMedGoogle Scholar
  8. Nakajima M, Sugano H, Iimura Y, Higo T, Nakanishi H, Shimoji K, Karagiozov K, Miyajima M, Arai H: Sturge-Weber syndrome with spontaneous intracerebral hemorrhage in childhood. J Neurosurg Pediatr. 2014, 13 (1): 90-3. 10.3171/2013.9.PEDS133.View ArticlePubMedGoogle Scholar
  9. Kamiya K, Hori M, Miyajima M, Nakajima M, Suzuki Y, Kamagata K, Suzuki M, Arai H, Ohtomo K, Aoki S: Axon diameter and intra-axonal volume fraction of the corticospinal tract in idiopathic normal pressure hydrocephalus measured by q-space imaging. PLoS One. 2014, 9 (8): e103842-10.1371/journal.pone.0103842.PubMed CentralView ArticlePubMedGoogle Scholar
  10. Tsutsumi S, Ogino I, Miyajima M, Nakamura M, Yasumoto Y, Arai H, Ito M: Cranial Arachnoid Protrusions and Contiguous Diploic Veins in CSF Drainage. AJNR Am J Neuroradiol. 2014, 35 (9): 1735-9. 10.3174/ajnr.A4007.View ArticlePubMedGoogle Scholar

Copyright

© Miyajima et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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