LOVA
Table of Contents
Introduction
LOVA stands for long-standing ventriculomegaly of the adults. Shizuo Oi in 1996 described LOVA as a distinct entity of adult hydrocephalus.
Definition of LOVA is controversial. The two common criteria for diagnosing LOVA are the Oi and the Vad criteria.
Diagnostic criteria
Oi S et. al in 2000 published their criteria for LOVA. This was based on clinico-radiological findings.
| Oi criterion |
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Clinical features
The main clinical features of LOVA are difficulty in mobilization, impaired cognition and bladder control.
The difficulty in walking could be due to gait and balance problems. The cognitive impairment includes dementia, apathy, low IQ. The main bladder problem is urinary incontinence.
Walking difficulty | COgnitive difficulty | Poor bladder control | |
|---|---|---|---|
Montemurro | 100% | 71% | 74.2% |
Table 3: The incidence of major symptoms in patients with LOVA
| Clinical features |
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Table 4: Clinical features related to LOVA (Montemurro N et. al)
Classification
Patients with LOVA could be divided into those with obstruction to flow at the aqueduct of Sylvius or not.
Figure 1: Classifying LOVA based on MRI findings relating to the aqueduct of Sylvius and floor of the third ventrlcle
Neuropsychology
Oi S et. al (1996) reported that half of their patient with LOVA had mental retardation or dementia (check the original reference). LOVA may or may not be associated with aqueduct stenosis. Al-Jumaily et. al (2012) undertook pre-op neuropsychological studies in their patients with LOVA associated with aqueduct stenosis.
Al-Jumaily et. al found that mean score on Repeatable battery for the assessment of neuropsychological status (RBANS) the mean score for each of the parameters (immediate memory, visuospatial/constructional, language, attention, delayed memory) were lower than for the average population; the total mean score was 71. This is lower than that of general population which is around 100.
Post-operatively 6 of the 9 patients reported subjective improvement in memory. It would appear 11 of the 20 patients (i.e.55% of the patients) did not undergo post-op neuropsychological assessment. There was no report of the results of post-op formal neuropsychological assessment (RBANS). The authors found the there was no statistically significant difference in the Hospital Anxiety and Depression Scale (HADS) score between the patients they had studied and the general population.
Management
Conservative management
Surgical management
Ventriculoperitoneal shunt
Endoscopic third ventriculostomy (ETV)
Reference
Al-Jumaily M, Jones B, Hayhurst C, Jenkinson MD, Murphy P, Buxton N, Mallucci C. Long term neuropsychological outcome and management of ‘decompensated’ longstanding overt ventriculomegaly in adults. Br J Neurosurg. 2012 Oct; 26(5): 717-21. doi: 10.3109/02688697.2012.673647. Epub 2012 Apr 3. PMID: 22468979.
Montemurro N, Indaimo A, Di Carlo DT, Benedetto N, Perrini P. Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV). Int J Environ Res Public Health. 2022 Feb 9;19(4):1926. doi: 10.3390/ijerph19041926. PMID: 35206112; PMCID: PMC8872207.
Oi S, Sato O, Matsumoto S: Neurological and medico-social problems of spina bifida patients in adolescence and adulthood. Childs Nerv Syst 12:181–187, 1996
Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, Tsugane R, Sato O. Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg. 2000; 92(6): 933-40. doi: 10.3171/jns.2000.92.6.0933. PMID: 10839252.
Ved R, Leach P, Patel C. Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA) Acta Neurochir (Wien) 2017; 159(1): 71–79. doi: 10.1007/s00701-016-2998-7
Ganealingam Narenthiran on December 11, 2022