{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:56:33Z","timestamp":1793141793633,"version":"4.5.0"},"reference-count":6,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Management of idiopathic normal-pressure hydrocephalus (iNPH) is hard because the diagnosis is difficult and shunt surgery has high complication rates. An important complication is overdrainage, which often can be treated with adjustable\u2013shunt valve manipulations but also may result in the need for subdural hematoma evacuation. The authors evaluated shunt surgery overdrainage complications in iNPH and their relationship to lumbar puncture opening pressure (LPOP).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors reviewed the charts of 164 consecutive patients with iNPH who underwent shunt surgery at their institution from 2005 to 2011. They noted age, sex, presenting symptoms, symptom duration, hypertension, body mass index (BMI), imaging findings of atrophy, white matter changes, entrapped sulci, LPOP, valve opening pressure (VOP) setting, number of valve adjustments, serious overdrainage (subdural hematoma requiring surgery), radiological overdrainage (subdural hematomas or hygroma seen on postoperative imaging), clinical overdrainage (sustained or postural headache), other complications, and improvements in gait, urine control, and memory.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Eight patients (5%) developed subdural hematomas requiring surgery. All had an LPOP of greater than 160 mm H<jats:sub>2<\/jats:sub>O and an LPOP-VOP of greater than 40 mm H<jats:sub>2<\/jats:sub>O. Radiological overdrainage was more common in those with an LPOP of greater than 160 mm H<jats:sub>2<\/jats:sub>O than in those with an LPOP of less than 160 mm H<jats:sub>2<\/jats:sub>O (38% vs 21%, respectively; p = 0.024). The BMI was also significantly higher in those with an LPOP of greater than 160 mm H<jats:sub>2<\/jats:sub>O (median 30.2 vs 27.0, respectively; p = 0.005).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Serious overdrainage that caused subdural hematomas and also required surgery after shunting was related to LPOP and LPOP-VOP, which in turn were related to BMI. If this can be replicated, individuals with a high LPOP should have their VOP set close to the LPOP, or even higher. In doing this, perhaps overdrainage complications can be reduced.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.7.jns13484","type":"journal-article","created":{"date-parts":[[2013,8,9]],"date-time":"2013-08-09T14:01:55Z","timestamp":1376056915000},"page":"1498-1502","source":"Crossref","is-referenced-by-count":52,"title":["Overdrainage shunt complications in idiopathic normal-pressure hydrocephalus and lumbar puncture opening pressure"],"prefix":"10.3171","volume":"119","author":[{"given":"Qurat ul Ain","family":"Khan","sequence":"first","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Wharen","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeet S.","family":"Grewal","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen S.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Division of Health Sciences Research, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Gordon","family":"Deen","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Reimer","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay A.","family":"Van Gerpen","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia E.","family":"Crook","sequence":"additional","affiliation":[{"name":"Division of Health Sciences Research, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neill R.","family":"Graff-Radford","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns13484","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1212\/WNL.39.12.1601","article-title":"Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly","volume":"39","author":"Graff-Radford","year":"1989"},{"key":"b2-jns13484","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"987","DOI":"10.3171\/jns.2005.102.6.0987","article-title":"Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients","volume":"102","author":"Marmarou","year":"2005"},{"key":"b3-jns13484","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1227\/01.NEU.0000175724.00147.10","article-title":"Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus","volume":"57","author":"McGirt","year":"2005"},{"key":"b4-jns13484","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1227\/NEU.0b013e318260fef7","article-title":"Assessment of a quick reference table algorithm for determining initial postoperative pressure settings of programmable pressure valves in patients with idiopathic normal pressure hydrocephalus: SINPHONI subanalysis","volume":"71","author":"Miyake","year":"2012"},{"key":"b5-jns13484","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2176\/nmc.52.775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: second edition","volume":"52","author":"Mori","year":"2012"},{"issue":"3 Suppl","key":"b6-jns13484","series-title":"Neurosurgery","first-page":"S4","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/119\/6\/article-p1498.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/119\/6\/article-p1498.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/119\/6\/article-p1498.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T17:08:53Z","timestamp":1660496933000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/119\/6\/article-p1498.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,12]]},"references-count":6,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2013.7.jns13484","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,12]]}}}