Surgery

Treatment of Idiopathic Normal Pressure Hydrocephalus (iNPH)【Kishiwada Tokushukai Hospital】

implementation facility

Kishiwada Tokushukai Hospital

Facility Details

program name: Treatment of Idiopathic Normal Pressure Hydrocephalus (iNPH)【Kishiwada Tokushukai Hospital】

genre

Surgery：Surgery

program details: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a treatable form of dementia that can be improved with surgery. Shunt surgery is performed to regulate cerebrospinal fluid flow, aiming to improve gait and cognitive function.

requirement, condition for apply: Admission Criteria

1. Medical Information:
- Diagnosis (e.g., idiopathic normal pressure hydrocephalus)
- Detailed symptoms (e.g., gait disturbance, memory impairment, urinary incontinence)
- Examination results from other institutions (confirmation of ventricular enlargement via head MRI or CT)
- Presence of comorbidities (e.g., hypertension, diabetes, heart disease)

2. History of Treatment:
- History of neurosurgery or shunt surgery
- Current medications (e.g., anticoagulants, antiplatelet agents)
- Presence of allergies or adverse drug reactions

3. Age and Physical Fitness:
- Assessment of whether elderly or comorbid patients can tolerate surgery
- Evaluation of suitability for general anesthesia

4. Preoperative Tests:
- Confirmation of brain structure via MRI during an outpatient visit, showing characteristics of idiopathic normal pressure hydrocephalus
- Assessment of symptom improvement after cerebrospinal fluid (CSF) drainage using diagnostic tests such as the Tap Test

5. Renal Function:
- Evaluation of renal function is required due to the potential use of contrast agents (renal impairment may limit treatment options)

6. Postoperative Management and Follow-Up:
- Cooperation with regular follow-up after shunt surgery
- Ability to attend outpatient visits and follow instructions, especially since MRI scans may affect the shunt valve

precaution, contraindication: 【Precautions and Contraindications】

1. Cases Not Suitable for Treatment:
- Patients with severe heart or kidney disease who cannot tolerate surgery or anesthesia may have limited treatment options.
- Patients at high risk for general anesthesia or those who do not show improvement during the Tap Test may also be unsuitable for shunt surgery.
- Patients with weakened immune systems at high risk for shunt infection require careful management.

2. Contraindications for Shunt Surgery:
- Patients taking antiplatelet or anticoagulant medications must discontinue them before surgery, which poses a risk of bleeding.
- Patients with allergies to contrast agents or impaired renal function may require alternative approaches to testing and follow-up due to the inability to use contrast agents.

3. Postoperative Complication Risks:
- Risks include infection, thrombosis, or shunt obstruction. Shunt obstruction can prevent CSF drainage and may necessitate additional surgery.
- There is a possibility of hydrocephalus recurrence or symptom relapse, making regular follow-up essential.

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# 【Important Pre-Treatment Information】

1. Preoperative Preparation:
- Patients must discontinue antiplatelet or anticoagulant medications under medical guidance before surgery.
- All preoperative tests, including MRI, CT, and the Tap Test, must be completed to predict treatment outcomes.

2. Postoperative Care and Risks:
- After shunt surgery, monitor for headaches, fever, or signs of infection, and contact a medical institution promptly if abnormalities occur.
- Shunt valves may be affected by magnetic fields during MRI scans. Inform your physician before undergoing MRI and follow appropriate precautions.

3. Lifestyle and Daily Precautions:
- Avoid physical impacts to the head and ensure no mechanical interference with the shunt device in daily activities.
- Reduce infection risks by maintaining hygiene, especially when caring for surgical wounds or during outings.

4. Regular Follow-Up:
- Undergo regular CT or ultrasound exams to monitor shunt function after surgery.
- Long-term follow-up is necessary to check the condition and functionality of the implanted shunt, with regular outpatient visits as instructed.

5. Emergency Response:
- If symptoms such as gait instability, worsening cognitive symptoms, or urinary incontinence recur after discharge, contact a medical institution promptly.
- If shunt malfunctions or symptoms relapse, early re-evaluation is essential. Confirm emergency contact details and the responsible physician’s information in advance.