Normal Pressure Hydrocephalus Treatment

Treatment Services

• Pre-surgery office visit: The neurosurgeon will review the case with the patient and make the final decision about whether surgery is a viable option. The neurosurgeon will consider the clinical presentation, neurological findings, results of the diagnostic testing and anesthesia risks. For those patients proceeding to a shunt surgery, the neurosurgeon will discuss the risks and possible benefits of surgery.
• Surgery: The treatment of normal pressure hydrocephalus involves the surgical placement of a shunt that diverts cerebrospinal fluid (CSF) from the brain to another part of the body.
• Many patients need to see their internist or cardiologist prior to surgery for pre-operative medical clearance.
• Patients need standard labs (blood, urine) and tests (EKG, chest x-ray) prior to surgery.
• Patients must stop taking aspirin, Plavix, Coumadin, and all non-steroidal medications (such as Motrin) at least 10 days prior to surgery.
• There are different types of shunt configurations, but the most commonly used at UCLA are the ventriculoatrial (VA) and ventriculoperitoneal (VP) shunt.
• Both share the placement of a catheter into the brain ventricle to access the CSF.
• The VA shunt diverts the CSF to the vein just above the atrium of the heart. (The catheter is inserted into the jugular vein.)
• The VP shunt diverts CSF to the abdominal (peritoneal) cavity.
• In nearly all cases, a programmable valve will be placed as part of the shunt system to control the amount of drainage.
• This valve will be set initially at the lowest drain rate (highest pressure setting) in order to minimize the risk of over-drainage complications.
• Because the valve is set at the lowest drainage setting, the patient might not see an improvement immediately after surgery.
• The valve will likely have to be reprogrammed in clinic a couple of times until the correct setting is achieved.
• The operation normally takes about 35 minutes, so patients are in the operating room for about an hour.
• Recovery: After being observed in the Recovery Room for another hour, the patient is moved to their hospital room. The next day, physical therapists will evaluate you. Patients expect a two- to three- day stay for the surgery.
• Follow-up: The patient will have a follow up visit with the neurosurgeon to evaluate progress make any necessary adjustments to the shunt.

• Procedure for adjusting valve.

  Valve adjustments: If a valve adjusted is needed, it is easy, quick, and painless.
• The decision whether to adjust the valve will depend on level of improvement. If the patient has not improved, then the valve will be adjusted to drain more. If the patient has not improved in two weeks, then it can be reset again.
• After every other valve adjustment, a computed tomography (CT) scan of the brain is obtained to determine if fluid is collecting between the brain and skull.
• Anywhere from zero to five adjustments may be needed.