====== Integra NPH low flow valve ======

[[Overdrainage]] and frequent [[reprogramming]] are common issues with [[programmable]] valves after [[ventriculoperitoneal shunt]] surgery for [[idiopathic normal pressure hydrocephalus]] (iNPH). [[Flow regulated valve]]s may address these limitations, but [[data]] on their [[efficacy]] are sparse. 

Wetzel et al., from the Center for Neurosurgery, University Hospital of [[Cologne]], [[Germany]], present a single-center experience with flow-regulated valves focusing on overdrainage and [[efficiency]].

Thirty-two patients with iNPH treated with the [[Integra]]® [[NPH Low Flow Valve]] were prospectively enrolled. Clinical evaluation was performed at baseline, postoperatively as well as 3 and 6 months after surgery. The [[outcome]] was assessed by employing the iNPH grading scale and the [[Mini Mental State Examination]] ([[MMSE]]). Overdrainage was assessed clinically and radiologically by [[computed tomography]].

The mean patient [[age]] was 71 years. All patients presented with [[gait disorder]], 29 had [[cognitive disorder]] and 25 had [[urinary incontinence]]. The mean duration of [[symptom]]s was 22.9 months. At 3-month follow-up, 25/31 patients (80.6%) improved on the total iNPH score by at least 5 points (p < 0.001). The mean [[MMSE]] score increased from 24.5 to 26.1 points (p = 0.013). After 6 months, the improvement rates of the iNPH (82.1%) and the MMSE scores (26.8 points) were stable. The rate of clinically significant [[overdrainage]] was 3.2%. One patient presented with [[subdural hygroma]]s that necessitated evacuation. In the remaining patients, clinical and radiological signs of overdrainage were absent.

The use of the Integra® NPH Low Flow Valve leads to a good neurological outcome and has low overdrainage rates without the need for reprogramming. These results are encouraging and justify further investigation of this valve
((Wetzel C, Goertz L, Schulte AP, Goldbrunner R, Krischek B. Minimizing
overdrainage with flow-regulated valves - Initial results of a prospective study 
on idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg. 2018 Jul
23;173:31-37. doi: 10.1016/j.clineuro.2018.07.017. [Epub ahead of print] PubMed
PMID: 30071502.
)).