OBJECTIVES: To determine the prognostic potential of S100B protein in patients with craniocerebral injury, correlation between S100B protein and time, selected internal diseases, body habitus, polytrauma, and season. METHODS: We examined the levels of S100B protein in 124 patients with traumatic brain injury (TBI). RESULTS: The S100B protein level 72 h after injury and changes over 72 h afterwards are statistically significant for prediction of a good clinical condition 1 month after injury. The highest sensitivity (81.4%) and specificity (83.3%) for the S100B protein value after 72 h was obtained for a cut-off value of 0.114. For the change after 72 h, that is a decrease in S100B value, the optimal cut-off is 0.730, where the sum of specificity (76.3%) and sensitivity (54.2%) is the highest, or a decrease by 0.526 at the cut-off value, where sensitivity (62.5%) and specificity (62.9%) are more balanced. The S100B values were the highest at baseline; S100B value taken 72 h after trauma negatively correlated with GCS upon discharge or transfer (r=-0.517, P<0.0001). We found no relationship between S100B protein and hypertension, diabetes mellitus, BMI, or season when the trauma occurred. Changes in values and a higher level of S100B protein were demonstrated in polytraumas with a median of 1.070 (0.042; 8.780) μg/L compared to isolated TBI with a median of 0.421 (0.042; 11.230) μg/L. CONCLUSION: S100B protein level with specimen collection 72 h after trauma can be used as a complementary marker of patient prognosis.

• MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• S-100 kalcium vázající protein G, podjednotka beta * krev   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• traumatické poranění mozku * krev   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: The annual number of spinal fusion procedures has been increasing and is well documented worldwide. The O-arm is slowly becoming the standard for transpedicular screw insertion. The accuracy and safety of this method have been confirmed by many studies. Therefore, the learning curve of this method and its use by younger surgeons is the focus of our investigation. Longer operative time and radiation exposure to the patient are its only disadvantages. Our aim was to evaluate the learning curve of neurosurgical residents receiving specialist training and to demonstrate the safety and accuracy compared to the conventional C-arm-guided screw insertion used in the surgical management of spondylolisthesis. MATERIAL AND METHODS: Two groups of patients were evaluated - a retrospective cohort composed of patients with degenerative lumbar spinal instability indicated for C-arm-guided posterior transpedicular screw fixation and a prospective group of patients with the same diagnosis and surgical indication for O-arm-navigated screw insertion. In the retrospective group, the surgeons were largely experienced certified spine surgeons and neurosurgeons, whereas in the prospective group there were mainly neurosurgical residents receiving specialist training under the supervision of a certified physician. Both groups underwent a postoperative CT scan to evaluate the pedicle screw malposition using the Grade system and the anatomical plane of malposition. The operative times for both groups were recorded and for the O-arm navigated group a learning curve from the introduction of the method was generated. The values obtained were statistically analysed. RESULTS: A relatively favourable learning curve of the O-arm-navigation was obtained, with operative times approximating the Carm-guided group at two years after the introduction of the method. Safety of the O-arm navigation applied by less experienced surgeons was confirmed through statistically significantly higher accuracy achieved in the O-arm group at the expense of longer operative times. Also, a significantly lower number of significant Grade 2 and 3 malposition was reported in the O-arm group. DISCUSSION: The higher accuracy of transpedicular screw insertion in the navigation method has been confirmed multiple times. In our study, even in the group of less experienced surgeons. The favourable learning curve of neurological residents receiving specialist training is less documented. Time efficiency of the method and its safety when applied by younger surgeons could help make O-arm navigation the new gold standard in spine surgery. The longer operative time, the purchase price of the device, and a relatively higher radiation exposure to the patient continue to be its disadvantages. CONCLUSIONS: Based on the data obtained, a conclusion can be drawn that the O-arm navigation in spine surgery represents a safer and more accurate method for transpedicular fixation compared to the conventional C-arm technique, even when used by less experienced surgeons. In future, we should focus on increasing its time-efficiency. We are convinced that the navigationassisted spinal instrumentation will soon become a necessity for spine surgery centres. KEY WORDS: O-arm, transpedicular fixation, spondylolisthesis, fusion, navigation, learning curve.

• MeSH
• bederní obratle * chirurgie   MeSH
• chirurgie s pomocí počítače metody   přístrojové vybavení   MeSH
• délka operace MeSH
• fúze páteře přístrojové vybavení   metody   výchova   MeSH
• kostní šrouby MeSH
• křivka učení * MeSH
• kurzy a stáže v nemocnici MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• spondylolistéza * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVES: To determine the treatment effect of corticosteroids in periradicular therapy (PRT) for radicular pain and to compare different types of corticosteroids and ozone. We also examined the effect in different indication groups for periradicular therapy for each type of treatment agent. BACKGROUND: Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anesthetic and corticosteroids or ozone application for radicular pain. This is the first study to compare different types of corticosteroids and ozone. METHODS: Eligible patients with radicular pain who failed conservative management were divided into five indication groups and prospectively followed to assess the PRT effect of corticosteroids or ozone application. PRT was performed under computer tomography (CT) monitoring. A set of three PRT applications in three weeks was applied and the outcome was evaluated using a visual analogue score for back and leg pain. The in-group and between-group treatment effect was tested using the Wilcoxon signed-rank test and the Kruskal-Wallis H-test with Dunn's post-hoc tests, respectively. The dependency between treatment effectiveness and indication for each group was tested using the Kruskal-Wallis H-test and Dunn's post-hoc tests. RESULTS: We prospectively followed 150 patients, randomized into three groups of 50 patients each. The follow-up rate was 100%. All three treatment agents showed a statistically significant treatment effect (P<0.001). The statistically significant effect was higher in betamethasone (Diprophos) versus methylprednisolone (Depomedrone) (P=0.019) and Diprophos versus ozone (P<0.001). Diprophos also showed the highest decrease of VAS after therapy versus VAS prior to therapy (median decrease = 4) compared to Depomedrone and ozone (median decrease = 3 and 2, respectively). The statistically significant outcome was better with the indication of spondylolisthesis and disc herniation (P=0.019) indication for the Diprophos group and between spinal stenosis and spondylolisthesis (P=0.022) and spondylolisthesis and disc herniation (P=0.016) for the ozone group. CONCLUSION: Clinical improvement occurred in all three groups but Diprophos showed the statistically best treatment effect compared to Depomedrone and ozone. Disc herniation resulting in radicular pain had a statistically significant better effect in comparison with spondylolisthesis in the Diprophos and ozone groups, but the ozone group showed heterogeneity depending on treatment effect and indication.

• MeSH
• bederní obratle MeSH
• betamethason terapeutické užití   MeSH
• bolest MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• lidé MeSH
• ozon * terapeutické užití   MeSH
• prospektivní studie MeSH
• spondylolistéza * MeSH
• výhřez meziobratlové ploténky * farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODS The study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTS The cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500- 1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSION The beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of tranexamic acid may not be that distinct. In our study of single-level decompressions and stabilizations, no reduction in the actual intraoperative bleeding was confirmed at the given dosage. Its effect was seen only in the postoperative period in a significant reduction of blood loss into the drain, thus also in the total blood loss, although the difference between 910 (500, 1420) mL and 860 (470, 1410) mL was not that significant. CONCLUSIONS By intravenous application of tranexamic acid in 2 bolus doses in single-level decompression and stabilization of the lumbar spine a statistically significant reduction in postoperative blood loss into the drain and also total blood loss was confirmed. The reduction in the actual intraoperative blood loss was not statistically significant. No difference was observed in the number of administered transfusions. Following the tranexamic acid administration, a lower number of postoperative symptomatic wound hematomas was recorded, but the difference was not statistically significant. Key words: tranexamic acid, spinal surgeries, blood loss, postoperative hematoma.

• MeSH
• antifibrinolytika * MeSH
• hematom prevence a kontrola   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• pooperační krvácení prevence a kontrola   farmakoterapie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Úvod: Dekompresivní kraniektomie (DK) je život zachraňující neurochirurgický výkon s několika technickými možnostmi provedení. Cíl: Cílem této studie bylo porovnat výsledky operační techniky DK s duroplastikou a bez provedené duroplastiky na dvou neurochirurgických pracovištích. Metodika: Retrospektivní bicentrická studie hodnotila výskyt komplikací (tj. infekční, likvorová píštěl, hematom) u jednotlivých technik. Výsledky: Ve studii nebyl prokázán statisticky signifikantně vyšší výskyt komplikací jako jsou infekce (p = 0,539), likvorová píštěl (p = 0,826) či hematom (p = 0,720). V obou sledovaných souborech po kranioplastice nebyly zaznamenány infekční komplikace nebo likvorová píštěl. Komplikace ve formě hematomu byla statisticky nevýznamná (p = 0,155). Byl zjištěn statisticky významný rozdíl v operačním čase kranioplastiky provedené po DK s duroplastikou (medián 53 min) a po DK bez provedené duroplastiky (medián 90 min; p = 0,006). Závěr: DK bez provedení duroplastiky je potenciální bezpečná varianta, která není zatížená vyšším výskytem komplikací ve smyslu infekce nebo vzniku likvorové píštěle a hematomu.

Background: Decompressive craniectomy (DC) is a life-saving neurosurgical procedure with several technical options. Aim: The aim of this study was to compare the results of the DC surgical technique with and without duroplasty performed at two neurosurgery departments. Methods: A retrospective bicentric study evaluated the occurrence of complications (i.e., infection, cerebrospinal fluid fistula, hematoma) in both compared techniques. Results: The study did not demonstrate a statistically significantly higher incidence of complications such as infection (P = 0.539), cerebrospinal fluid fistula (P = 0.826) or hematoma (P = 0.720). No infectious complications or cerebrospinal fluid fistula were recorded in both observed groups after cranioplasty. The complication in the form of hematoma was statistically insignificant (P = 0.155). A statistically significant difference was found in the operative time of cranioplasty performed after DC with duroplasty (median 53 min) and after DC without duroplasty (median 90 min; P = 0.006). Conclusion: DC without duroplasty is a potentially safe option that is not burdened by a higher incidence of complications in terms of infection or the formation of cerebrospinal fluid fistula and hematoma.

• Klíčová slova
• duroplastika, kranioplastika,
• MeSH
• dekompresní kraniektomie metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• traumatické poranění mozku * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Coccygodynia, or tailbone pain, is the most common in women after trauma (complicated childbirth, fall). This pain can be treated conservatively (by using analgesics, local injections, physiotherapy) or by surgical coccygectomy. In the presented article, a set of five female patients is evaluated, in whom, after the failing conservative therapy, coccygectomy was indicated for persistent coccygodynia. In all female patients, improvement of their clinical condition and alleviation of pain were reported. Coccygectomy has its place in the management of coccygodynia and in correctly chosen patients significant pain reduction can be expected. Key words: coccygodynia, coccyx, coccygectomy, trauma.

• MeSH
• bolesti zad MeSH
• kostrč zranění   chirurgie   MeSH
• lidé MeSH
• lumbalgie * etiologie   chirurgie   MeSH
• muskuloskeletální bolest * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Autoři prezentují kazuistiku vzácného syndromu útlaku nervus interosseus antebrachii anterior ("Kiloh-Nevinův syndrom"). Pacientku nejprve vyšetřili ve spádové neurologické ambulanci. Na základě minimální neuropatie nervus medianus v karpálním tunelu, verifikované na EMG a na základě klinického nálezu byla stanovena diagnóza syndromu karpálního tunelu. Konzilium na Neurochirurgické ambulanci autorského pracoviště konstatovalo nepřítomnost klinických symptomů korespondujících s uvedenou diagnózou, a to vč. EMG nálezu. Doporučené EMG došetření odhalilo neuropatii nervus interosseus antebrachii anterior (Kiloh-Nevinovův syndrom). Pacientka podstoupila, po pokusu o konzervativní terapii, operační výkon s příznivým efektem.

Authors would like to present a case of an uncommon entrapment syndrome of the anterior antebrachial interosseal nerve ("The Kiloh-Nevin syndrome). Patient was first examined by an ambulatory neurologist. EMG verified minimal neuropathic finding of the median nerve and clinical presentation first lead to the diagnosis of carpal tunnel syndrome. After a neurosurgical consult on the authors departement we found the corresponding clinical presentation misleading including the EMG presentation. Newly recommended EMG uncovered anterior antebrachial interosseal nerve neuropathy (Kiloh-Nevin syndrome). After a failed conservative therapy, patient underwent a surgical intervention with a good outcome.

• MeSH
• elektromyografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mononeuropatie chirurgie   diagnóza   MeSH
• nervus medianus chirurgie   patologie   MeSH
• úžinové syndromy * chirurgie   diagnóza   patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Cíl: Cílem práce bylo stanovit roli prognostických možností proteinu S 100B jako možného biochemického markeru u pacientů s kraniocerebrálním poraněním. Soubor a metodika: Do pilotní studie bylo zařazeno celkem 22 pacientů s kraniocerebrálním poraněním verifikovaným CT. Byla sledována hladina proteinu S 100B do 3 h a dále po 8, 12, 24 a 72 h od úrazu. Výsledky: Při měření do 3 h od úrazu byly naměřeny nejvyšší hodnoty – medián 0,624 (0,166; 1,250) μg/l, které v následujících hodinách statisticky signifikantně poklesly. Prokázali jsme významnou středně silnou negativní korelaci mezi hodnotami proteinu S 100B naměřenými ve všech časech a vstupními hodnotami Glasgow Coma Scale (GCS), přičemž nejsilněji korelovaly po 72 h. Nebyla prokázána významná závislost hladin proteinu S 100B na věku pacientů. U sdružených poranění byla prokázána vyšší vstupní hladina proteinu – medián S 100B 1,250 (1,180; 3,380) μg/l než u izolovaných kraniotraumat – medián 0,438 (0,154; 0,681) μg/l. U pacientů s neuspokojivým klinickým stavem (GCS ≤ 12) 4. den hospitalizace byly prokázány významně vyšší hodnoty proteinu S 100B po 24 a 72 h. Nejspolehlivější predikce příznivého klinického stavu 4. den (GCS ≥ 13) byla možná po 72 h při hladině proteinu S 100B ≤ 0,132 μg/l se senzitivitou 94,1 % a specificitou 100 %. Závěr: Studie podporuje možnost potenciálního prognostického použití sérové hodnoty proteinu S 100B u pacientů s kraniocerebrálním traumatem.

Aim: The aim of this study was to explore prognostic capabilities of protein S 100B as a possible biochemical marker in patients with traumatic brain injury. Materials and methods: In this pilot study, we enrolled 22 patients with a traumatic brain injury verified on CT. S 100B levels were measured within 3 h and later on after 8, 12, 24 and 72 h following the trauma. Results: Initial checks of levels within 3 h following the trauma proved to be at a peak median 0.624 (0.166; 1.250) μg/L, and in the following hours the values declined with statistical significance. We proved a significant moderate negative correlation between the values of protein S 100B measured at all time checkpoints with initial Glasgow Coma Scale (GCS) values, with the highest correlation after 72 h. We did not prove any significant dependency of the levels of protein S100B and patient’s age. Higher levels of protein S 100B were found in patients with additional injuries with a median of 1.250 (1.180; 3.380) μg/L compared to patients with isolated traumatic brain injury with a median of 0.438 (0.154; 0.681) μg/L. Patients with unsatisfactory clinical outcome (GCS ≤ 12) on Day 4 were found to have higher levels of protein S 100B after 24 and 72 h. The most reliable cut-off level of protein S 100B for predicting favorable clinical outcome (GCS ≥ 13) on Day 4 was possible after 72 h at the level of ≤ 0.132 μg/L with 94.1% sensitivity and 100% specificity. Conclusion: The study supports the potential prognostic use of serum S 100B protein in patients with with traumatic brain injury.

• Klíčová slova
• Glasgow Coma Scale,
• MeSH
• klinická studie jako téma MeSH
• kraniocerebrální traumata * diagnóza   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• poranění mozku * diagnóza   MeSH
• S-100 kalcium vázající protein G, podjednotka beta * analýza   MeSH
• stupeň závažnosti nemoci MeSH
• ukazatel závažnosti úrazu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.

• MeSH
• adenom * diagnostické zobrazování   chirurgie   MeSH
• baze lební * diagnostické zobrazování   chirurgie   MeSH
• chirurgie s pomocí počítače * metody   MeSH
• dospělí MeSH
• hypofýza * diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory hypofýzy * diagnostické zobrazování   chirurgie   MeSH
• neuronavigace metody   MeSH
• peroperační doba MeSH
• pilotní projekty MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• senioři MeSH
• transanální endoskopická chirurgie * metody   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECT: Idiopathic normal pressure hydrocephalus (iNPH) is the only variant of dementia disorders possibly treatable by neurosurgical intervention. iNPH is a neurodegenerative condition clinically characterized by gait ataxia, urinary incontinence, and memory disturbance. We present one of the largest single-center studies, which was designed to prove efficacy of our low-pressure setting of gravitational valve at all three symptoms of iNPH and to find statistically significant cut-off time for best clinical improvement according to the duration of symptoms. METHODS: Sixty-one consecutive patients (mean age 74.9 ± 5.3) with iNPH were prospectively observed from the time of surgery with minimal 6 months follow-up. All patients underwent implantation of the same type of gravitational valve with the same setting-pro GAV with low opening pressure at 5 cm H2O-and were operated by the same team of 2 neurosurgeons. We statistically evaluated gait disturbance, psychological changes, and incontinence preoperatively and at 6 months after surgery and timing of the surgery according to the duration of symptoms and to the age. RESULTS: Paired t test showed a statistically significant increase in MMSE, a statistically significant decrease in 10-m walk test and 360 deg. rotation test (p < 0.0001). The correlation among the change of the MMSE, the walk test, and the rotation test, and the age and time of symptoms' duration was verified by Pearson's correlation coefficient. Pearson's correlation coefficient showed a medium strong correlation between the change of MMSE and the time of symptoms (r = - 0.580; p < 0.0001) and between the change of the number of steps and the time of symptoms (r = 0.517, p < 0.0001). There was a statistically significant weak (poor) correlation between the change of the walk test and the time of symptoms (r = 0.351, p = 0.006). All 3 ROC tests confirmed optimal cut-off for the best improvement of symptoms as 9.5 months of the symptom duration. CONCLUSIONS: We proved statistical significant optimal cut-off for the best improvement of the symptoms as 9.5 months of the symptom duration. This study also confirmed successful treatment of iNPH with VP shunting using low pressure setting of gravitational valve with overall improvement in 75% and low over drainage complications in 5% We proved statistically significant increase in MMSE, decrease in 10 m walk test and number of steps test, p < 0.0001.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• normotenzní hydrocefalus chirurgie   MeSH
• pooperační komplikace epidemiologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ventrikuloperitoneální zkrat škodlivé účinky   přístrojové vybavení   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH