EFFECTIVENESS OF SHUNTING IN PATIENTS WITH NORMAL-PRESSURE HYDROCEPHALUS PREDICTED BY TEMPORARY, CONTROLLED-RESISTANCE, CONTINUOUS LUMBAR DRAINAGE - A PILOT-STUDY

From 1984 to 1992 15 consecutive cases of normal pressure hydrocephalu s were included in this pilot study. A series of tests included CT of the brain, grading of the cognitive mental state with the mini-mental state examination; urodynamic studies, and gait evaluation. These test s were carried out on admission, and repeated on day 1, day 3, and day 5 after controlled-resistance, continuous lumbar drainage (CRCLD). Du ring this period, eight patients showed significant improvements of co gnitive mental state, urodynamic studies, or gait and were regarded as CRCLD responders; the remaining seven patients were regarded as CRCLD non-responders. The CRCLD was routinely removed on day 6 after the dr ainage procedure and a ventriculoperitoneal (VP) or a lumboperitoneal (LP) shunt was randomly selected for each patient. The tests were repe ated one week after shunting and a year later. All the CRCLD responder s continued to benefit from shunting at one week and one year after th e procedure irrespective of the type of shunting they received. By com parison, none of the CRCLD nonresponders showed any improvement a year after the shunting. In conclusion, CRCLD proved to be a safe and effe ctive way to predict the effectiveness of shunting in patients with no rmal pressure hydrocephalus.