This is 2 of 2 reports.Other mfg report number: 9612007-2018-00022.Clinical neurology and neurosurgery (2018) published; ¿minimizing overdrainage with flow-regulated valves ¿ initial results of a prospective study on idiopathic normal pressure hydrocephalus¿ (inph).The objective of the article was to present the treatment results of patients treated with flow- regulated valves.The short- and midterm neurological outcome and report on overdrainage and complication rates were analyzed.From july 2013 to december 2017, thirty-two patients with inph treated with the integra nph low flow valve were prospectively enrolled.Clinical evaluation was performed at baseline, postoperatively as well as 3 and 6 months after surgery.The outcome was assessed by employing the inph grading scale and the mini mental status examination (mmse).Overdrainage was assessed clinically and radiologically by computed tomography.Patients characteristics: 11 females and 21 males.Age range 55-84.All patients presented with gait disturbance, 29 patients experiences cognitive impairment and 25 presented with urinary incontinence.Complications: one patient developed both-sided subdural hygromas 6 months after shunt implantation.The patient complained about tinnitus and the cranial ct scan showed slightly narrowed ventricles indicating overdrainage.Since there are no adjustment options of the flow-regulated valve, the hygromas were eventually evacuated via subdural drain and the integra low flow valve was exchanged to an adjustable sophy mini sm8 valve (sophysa).In another patient, the presenting symptoms of the patient initially improved after implantation of the flow-regulated valve and subsequently became worse again.Assuming there was a valve malfunction, the valve was exchanged for a sophy mini sm8 valve (sophysa).Following revision surgery, the symptoms improved again.One patient developed a shunt infection one month after shunt implantation that required shunt removal and antibiotic therapy via an external ventricular drain.Results: at 3-month follow-up, 25/31 patients (80.6%) improved on the total inph score by at least 5 points.The mean mmse score increased from 24.5 to 26.1 points.After 6 months, the improvement rates of the inph (82.1%) and the mmse scores (26.8 points) were stable.Conclusion: this prospective study suggests that the use of flow-regulated valves can lead to neurological improvement in shunted inph patients with a low risk of overdrainage.Moreover, the handling of these valve types is uncomplicated, since verification of the valve settings after mri and frequent reprogramming become indispensable.Further studies with a prospective design and long-term follow-up results will be necessary to draw a definite conclusion for flow-regulated valves and to establish a standardized clinical follow-up protocol.
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