Incidence and outcome of surgery for adult hydrocephalus patients in Sweden

Sundström, Nina; Malm, Jan; Laurell, Katarina; Lundin, Fredrik; Kahlon, Babar; Cesarini, Kristina Giuliana; Leijon, Göran; Wikkelsø, Carsten

doi:10.1080/02688697.2016.1229749

Cited by 46 publications

(50 citation statements)

References 17 publications

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“…Another explanation for our lower improvement rate was that our inclusion was consecutive and encompassed elderly patients and patients with severe comorbidity who would have been excluded in many prospective studies with strict inclusion criteria. 5 The length of follow-up in the present study was 12 months, which is in line with the majority of previous studies reporting outcome. 4 In contrast to our results, Thompson et al reported that 83% of their patients over 80 years improved.…”

Section: Clinical Outcome Of Shunt Surgerysupporting

confidence: 90%

“…6 However, our improvement rate is in line with a large registry study from Sweden using a similar method for clinical evaluation, with 58% improvement. 5 The length of follow-up in the present study was 12 months, which is in line with the majority of previous studies reporting outcome. 4 Studies with follow-up time longer than three years report slightly lower improvement rates than studies with short follow-up.…”

Section: Clinical Outcome Of Shunt Surgerysupporting

confidence: 90%

“…while recent reports propose that age alone should not exclude patients from surgery 6,7. In a recent study by Sundström et al, patients over 80 years had significantly poorer outcome, measured using the modified Rankin scale, than younger patients, but there was no difference between age groups when measured using the iNPH scale or MMSE 5. In the present study, increasing age was associated…”

supporting

confidence: 46%

“…3 The prevalence appears to increase with age. 4 Whether or not these outcome rates hold for older patients is not fully clarified; there are reports that high age could be a negative predictor for shunt surgery outcome, 5 while more recent reports propose that age alone should not exclude patients from surgery. 4 Whether or not these outcome rates hold for older patients is not fully clarified; there are reports that high age could be a negative predictor for shunt surgery outcome, 5 while more recent reports propose that age alone should not exclude patients from surgery.…”

Section: Introductionmentioning

confidence: 99%

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Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

et al. 2019

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Objectives:The prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH.The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH.Methods: All 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included. Hellström iNPH scale, without the neuropsychological tests, was calculated preoperatively and at follow-up 12 months after shunt surgery. Outcome was defined as the difference between the post-operative and preoperative iNPH scale scores. A multivariable model was used to investigate the predictive effects of age and vascular comorbidity on shunt surgery outcome. Results:In a multivariable analysis of covariance (ANCOVA) with post-operative outcome as the dependent variable, increasing age (years, B = −0.63, P < .001) and history of ischaemic stroke (B = −10.06, P = .0038) were negative predictors of shunt surgery outcome after controlling for waiting time for surgery, symptom severity at preoperative control, presence of diabetes mellitus, hypertension, hyperlipidaemia, history of myocardial infarction, duration of symptoms and shunt complications. Conclusions:High age and established cerebrovascular disease are associated with less favourable outcome after shunt surgery in patients with iNPH.

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Section: Clinical Outcome Of Shunt Surgerysupporting

confidence: 90%

Section: Clinical Outcome Of Shunt Surgerysupporting

confidence: 90%

supporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

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Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

et al. 2019

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“…Shunt surgery is a common treatment for iNPH, and the incidence of surgery has increased over the last decade. 17 In Sweden, adjustable shunt valves have been used to a varying extent since the beginning of the 1990s, 20 and when fixed valves are still applied, it is often for shortterm economic reasons. Considering that SDHs were as common in patients having fixed as well as adjustable shunts, health economics investigations might well prove adjustable shunts to be a less expensive option despite their higher purchase price.…”

Section: Treatment Of Sdhmentioning

confidence: 99%

Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

Sundström¹,

Lagebrant

Eklund³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Subdural hematoma (SDH) is the most common serious adverse event in patients with shunts. Adjustable shunts are used with increasing frequency and make it possible to noninvasively treat postoperative SDH. The objective of this study was to describe the prevalence and treatment preferences of SDHs, based on fixed or adjustable shunt valves, in a national cohort of patients with shunted idiopathic normal pressure hydrocephalus (iNPH), as well as to evaluate the effect of SDH and treatment on long-term survival. METHODS Patients with iNPH who received a CSF shunt in Sweden from 2004 to 2015 were included in a prospective quality registry (n = 1846) and followed regarding SDH, its treatment, and mortality. The treatment of SDH was categorized into surgery, opening pressure adjustments, or no treatment. RESULTS During the study period, the proportion of adjustable shunts increased from 75% to 95%. Ten percent (n = 184) of the patients developed an SDH. In 103 patients, treatment was solely opening pressure adjustment. Surgical treatment was used in 66 cases (36%), and 15 (8%) received no treatment. In patients with fixed shunt valves, 90% (n = 17) of SDHs were treated surgically compared with 30% (n = 49) in patients with adjustable shunts (p < 0.001). There was no difference in long-term patient survival between the SDH and non-SDH groups or between different treatments. CONCLUSIONS SDH remains a common complication after shunt surgery, but adjustable shunts reduced the need for surgical interventions. SDH and treatment did not significantly affect survival in this patient group, thus the noninvasive treatment offered by adjustable shunts considerably reduces the level of severity for this common adverse event.

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A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

石田¹,

Murayama

Kobayashi

2022

PCN Reports

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Background Idiopathic normal pressure hydrocephalus (iNPH) is a common form of dementia that causes gait disturbance, cognitive impairment, and urinary incontinence. iNPH is a “treatable dementia” that can be treated with shunt surgery, but this can be ineffective in some cases and can be accompanied by complications. As a result, many patients with iNPH do not undergo surgery. However, there is insufficient evidence on effective treatments other than surgical therapy. Case Presentation A 75‐year‐old woman presented to our hospital with a chief complaint of cognitive decline. She showed reduced motivation and inactivity. Brain magnetic resonance imaging showed a high score on the Evans Index (maximum width between bilateral lateral ventricular anterior horns/maximum intracranial cavity in the same slice). The subarachnoid space was enlarged at and below the Sylvian fissure, and narrowed at the higher arcuate region. She was diagnosed with iNPH. However, no shunt surgery was performed; 11 months later, she had a generalized convulsive seizure with loss of consciousness. An electroencephalogram showed generalized epileptic discharges. The possibility of surgery for her iNPH was ruled out. Levetiracetam prevented seizure recurrence and cognitive functions such as spontaneity and motivation were improved. Conclusion It is often assumed that surgery is the only effective treatment for patients with iNPH. However, as in the present case, symptomatic epileptic seizures may be a factor in dementia. Even in the absence of surgical treatment, we should examine the cause of dementia in patients with iNPH and consider pharmacological treatment, including antiepileptic drugs.

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Incidence and outcome of surgery for adult hydrocephalus patients in Sweden

Cited by 46 publications

References 17 publications

Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

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