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  • Role of Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunt in Idiopathic Normal Presure Hydrocephalus: Preliminary Results of a Randomized Clinical Trial

    Final Number:

    Fernando Pinto PhD; Felippe Saad; Matheus Oliveira MD; Renan Pereira; Fernanda de Miranda; Juliana de Tornai; Maria Romão; Eduardo Ribas; Emilia Valinetti; Manoel Teixeira

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Currently, the most often performed treatment for idiopathic normal pressure hydrocephalus (INPH) is the ventriculoperitoneal shunt (VPS), mainly with programmable valve implantation. The endoscopic third ventriculostomy (ETV) is a treatment option, with the advantage of not needing prosthesis implantation. The aim is to compare the functional neurological outcome after 12 months of treatment of patients with INPH through two different techniques: ETV or VPS.

    Methods: Trial Design: Randomised parallel, open label trial involving study of 42 patients with INPH and positive response to tap-test (TT), from January 2009 to January 2012. Interventions: ETV was performed with rigid endoscope with 30° lens (Minop®, AESCULAP) and VPS performed with fixed-pressure valve (PS Medical®, MEDTRONIC). The outcome occurs 12 months after surgery. The comparison of the neurological function outcome is carried out by the results of six clinical scales: mini-mental, Berg balance scale, dinamic gait index, functional independence measure, timed up and go and NPH scale.

    Results: There was statistically significant difference between both groups after 12 months of follow-up, and VPS group showed the best improvement results (ETV = 50%, VPS = 76.9%).

    Conclusions: Compared to ETV, VPS is superior and has the best functional neurological outcome 12 months after surgery.

    Patient Care: The neurosurgeon must be aware that ETV can be used for treatment of NPH patients, but VPS is superior and has the best functional neurological outcome 12 months after surgery

    Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of these two kinds of surgery (VPS and ETV) and identify an effective treatment for NPH

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