VCU Researcher Leads International Team In Developing Guidelines For Treating Hydrocephalus

Theinternational advisory panel led by Anthony Marmarou, Ph.D., professorof neurosurgery and director of research in the Virginia CommonwealthUniversity School of Medicine's Department of Neurosurgery, developedthe guidelines for normal pressure hydrocephaly, NPH, which appeared asa supplement to the September edition of Neurosurgery, the official,peer-reviewed journal of the Congress of Neurological Surgeons.

“NPHwas first identified in the mid-1960s,” said Marmarou. “Since thattime, there have been several thousand articles published in the field.We’ve taken all this information and reached consensus on how todiagnose and treat these patients.”

The new guidelines dealexclusively with idiopathic NPH, the form of NPH that develops from noknown cause. Doctors are advised of which tests to use to make adiagnosis and how to determine if treatment with a shunt – a flexibletube and valve – will help reverse or improve the condition. NPH istreated with the surgical implantation of a shunt that drains excessfluid from the brain and relieves pressure in the skull.

“Inthe early days doctors were reluctant to treat NPH because they didn’tthink treatment would help,” he said. “We now have evidence that showsa combination of diagnostic tests can predict 90 percent of the time ifa patient will respond to a shunt.”

According to the guidelines,physicians should carefully review the patient’s clinical history andconduct a physical exam and other diagnostic procedures including brainimaging with the use of a magnetic resonance imaging (MRI) or acomputerized tomography (CT) Scan.

If images reveal enlargedbrain ventricles, a lumbar puncture or spinal tap should be performedto see if symptoms are relieved. If responsive, doctors and patientsshould then weigh the risks and benefits of the surgery before having ashunt implanted.

NPH is a progressive neurological disorder thataffects about 375,000 people in the United States and typically occursin adults 55 years and older. It results from a build-up ofcerebrospinal fluid, which causes the ventricles of the brain toenlarge. This enlargement stretches the nerve tissue of the brain,causing a classic triad of symptoms that includes difficulty walking ora shuffling gait, dementia or mild confusion, and urinary urgency orincontinence. Many patients become extremely debilitated and requireconstant care. NPH, however, is one of the only forms of dementia thatcan be controlled or reversed with treatment.

The five-membermedical advisory panel was assembled in September 2000. The consensusguidelines were presented and reviewed by panels of experts in theUnited States, Europe and Asia.