Journal Article

Efficacy and safety of programmable compared with fixed anti-siphon devices for treating idiopathic normal-pressure hydrocephalus (iNPH) in adults – SYGRAVA: study protocol for a randomized trial

Scholz, Romy, Stengel, Dirk, Lemcke, Johannes, Meier, Ullrich

2018

Overview

Background Idiopathic normal-pressure hydrocephalus (iNPH) is a distinct form of dementia, characterized by gait ataxia, cognitive impairment and urinary incontinence. In contrast to all other causes of dementia (e.g., Alzheimer-type and others), ventriculoperitoneal (VP) shunt surgery may offer a curative treatment option to patients. While being a rather low-risk type of surgery, it may cause significant over- or underdrainage complications (e.g., headaches, dizziness, vomiting, intracerebral bleeding, etc.) during posture change. Anti-siphon devices (ASDs) are a group of technically different additional valves used in shunt surgery. They are designed to maintain intraventricular pressure within a normal physiological range regardless of patient position. Fixed ASDs proved to substantially lower the rate of overdrainage complications. No significant differences, however, were noted regarding underdrainage complications. Technical successors of fixed ASDs are programmable ASDs. The aim of this study is to evaluate whether programmable ASDs compared to fixed ASDs are able to avoid both over- and underdrainage complications. Methods/design In this investigator-initiated, multicenter randomized trial, 306 patients are planned to be recruited. Male and female patients aged ≥18 years with iNPH who are eligible for VP shunt surgery and meet all other entry criteria can participate. Patients will be randomized in a balanced 1: 1 fashion to a VP shunt with a programmable valve either supplemented with a fixed ASD, or a programmable ASD. Patients will be followed-up 3, 6 and, on an optional basis, 12 months after surgery. The primary outcome measure is the cumulative incidence of over- or underdrainage 6 months post surgery, as defined by clinical and imaging parameters. Discussion SYGRAVA is the first randomized trial to determine whether programmable ASDs reduce complications of drainage compared to fixed ASDs in patients with iNPH. The results of this study may contribute to health-technology assessment of different valve systems used for VP-shunt surgery, and determination of the future standard of care. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN13838310 . Registered on 10 November 2016.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adults / Alzheimer's disease / Analysis / Ataxia / Biomedicine / Care and treatment / Cerebrospinal fluid / Clinical trials / Cognitive ability / Data Interpretation, Statistical / Dementia / Diagnostic tests / Female / Gait / Health aspects / Health Sciences / Humans / Hydrocephalus / Hydrocephalus, Normal Pressure - surgery / Idiopathic normal-pressure hydrocephalus / Magnetic resonance imaging / Male / Medicine / Medicine & Public Health / Multicenter Studies as Topic / Outcome Assessment (Health Care) / Patients / Physiology / Programmable anti-siphon device / Randomized Controlled Trials as Topic / Randomized trial / Sample Size / Statistics for Life Sciences / Study Protocol / Surgery / Valves / Ventriculoperitoneal shunt / Ventriculoperitoneal Shunt - adverse effects / Ventriculoperitoneal Shunt - instrumentation