{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:56:26Z","timestamp":1793141786237,"version":"4.5.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>This study was undertaken to investigate whether a gradual reduction of the valve setting (opening pressure) decreases the complication rate in patients with idiopathic normal-pressure hydrocephalus (iNPH) treated with a ventriculoperitoneal (VP) shunt.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this prospective double-blinded, randomized, controlled, dual-center study, a VP shunt with an adjustable valve was implanted in 68 patients with iNPH, randomized into two groups. In one group (the 20\u20134 group) the valve setting was initially set to 20 cm H<jats:sub>2<\/jats:sub>O and gradually reduced to 4 cm H<jats:sub>2<\/jats:sub>O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium pressure setting of 12 cm H<jats:sub>2<\/jats:sub>O during the whole study period. The time to and type of complications (hematoma, infection, and mechanical problems) as well as overdrainage symptoms were recorded. Symptoms, signs, and outcome were assessed by means of the iNPH scale and the NPH grading scale.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Six patients in the 20\u20134 group (22%) and 7 patients in the 12 group (23%) experienced a shunt complication; 9 had subdural hematomas, 3 mechanical obstructions, and 1 infection (no significant difference between groups). The frequency of overdrainage symptoms was significantly higher for a valve setting \u2264 12 cm H<jats:sub>2<\/jats:sub>O compared with a setting &gt; 12 cm H<jats:sub>2<\/jats:sub>O. The 20\u20134 group had a higher improvement rate (88%) than the 12 group (62%) (p = 0.032). There was no significant relationship between complications and body mass index, the use of an antisiphon device, or the use of anticoagulants.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Gradual lowering of the valve setting to a mean of 7 cm H<jats:sub>2<\/jats:sub>O led to the same rate of shunt complications and overdrainage symptoms as a fixed valve setting at a mean of 13 cm H<jats:sub>2<\/jats:sub>O but was associated with a significantly better outcome.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.7.jns14283","type":"journal-article","created":{"date-parts":[[2014,9,5]],"date-time":"2014-09-05T14:02:47Z","timestamp":1409925767000},"page":"1257-1263","source":"Crossref","is-referenced-by-count":58,"title":["A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or \u201cfixed\u201d pressure valve settings"],"prefix":"10.3171","volume":"121","author":[{"given":"Terje","family":"S\u00e6hle","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital\u2013Rikshospitalet;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Farahmand","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Kristian","family":"Eide","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital\u2013Rikshospitalet;"},{"name":"Faculty of Medicine, University of Oslo, Norway; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Tisell","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Wikkels\u00f6","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3 Suppl","key":"b1-jns14283","series-title":"Neurosurgery","first-page":"S29","article-title":"Surgical management of idiopathic normal-pressure hydrocephalus","volume":"57","author":"Bergsneider","year":"2005"},{"key":"b2-jns14283","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"490","DOI":"10.3171\/jns.1998.88.3.0490","article-title":"Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts","volume":"88","author":"Boon","year":"1998"},{"key":"b3-jns14283","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/BF01410625","article-title":"Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types","volume":"136","author":"Borgbjerg","year":"1995"},{"key":"b4-jns14283","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1136\/jnnp.62.1.43","article-title":"Hydrodynamic properties of hydrocephalus shunts: United Kingdom Shunt Evaluation Laboratory","volume":"62","author":"Czosnyka","year":"1997"},{"key":"b5-jns14283","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1136\/jnnp-2012-302935","article-title":"A randomised trial of high and low pressure level settings on an adjustable ventriculoperitoneal shunt valve for idiopathic normal pressure hydrocephalus: results of the Dutch evaluation programme Strata shunt (DEPSS) trial","volume":"84","author":"Delwel","year":"2013"},{"key":"b6-jns14283","series-title":"Cerebrospinal Fluid Res","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1743-8454-7-5","article-title":"Cerebrospinal fluid pulse pressure amplitude during lumbar infusion in idiopathic normal pressure hydrocephalus can predict response to shunting","volume":"7","author":"Eide","year":"2010"},{"key":"b7-jns14283","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1227\/01.NEU.0000363408.69856.B8","article-title":"Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients","volume":"66","author":"Eide","year":"2010"},{"key":"b8-jns14283","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1136\/jnnp.2007.141416","article-title":"Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients","volume":"80","author":"Farahmand","year":"2009"},{"key":"b9-jns14283","series-title":"Dev Med Child Neurol","first-page":"646","article-title":"Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus: the need for a servo-valve shunt","volume":"15","author":"Hakim","year":"1973"},{"key":"b10-jns14283","series-title":"J Neurol Sci","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. 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