Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively

Abstract

Object. Shunt therapy in idiopathic normal pressure hydrocephalus (iNPH) can improve symptoms in 84% of patients 1 year postoperatively. Therefore, implantation of a ventriculoperitoneal shunt (VPS) prevents or at least prolongs the time during which patients are not dependent on care from others because of gait disorder or dementia. In this study, the medium-term results of modern shunt therapy were evaluated.Methods. The authors retrospectively studied outcome in iNPH patients in whom VPSs were implanted. At yearly follow-up examinations over at least 6 years, clinical symptoms were recorded according to the NPH recovery rate (NPH-RR): (preoperative Kiefer Scale [KS] score -postoperative KS score)/(preoperative KS score × 10). Time and cause of death over this period were also analyzed.Results. Among the 147 patients treated for iNPH in the period between 1997 and 2006, 69 had died at the time of the authors' survey. Sixty-one patients reached the 6-year examination. The median age was 64 years (range 33-83 years) at the time of VPS implantation and 73 years (range 41-91 years) at the time of this study. Six years after shunt implantation, the median KS score was significantly lower than the preoperative score (4.3 vs 8.1 points). Fifty-nine percent of 61 patients had an excellent outcome, 15% had satisfactory benefit, and 26% had unsatisfactory results 6 years postoperatively. Three of the 147 patients who underwent implantation of a VPS died of cerebral diseases 4-10 years postoperatively.Conclusions. Implantation of a VPS is a safe procedure and can improve symptoms in 74% of patients with iNPH in the longer term. Abbreviations used in this paper: CMI = Comorbidity Index; iNPH = idiopathic normal pressure hydrocephalus; KS = Kiefer Scale; NPH-RR = NPH recovery rate; VPS = ventriculoperitoneal shunt.

Health‐related quality of life in patients with idiopathic normal pressure hydrocephalus

“…Idiopathic normal pressure hydrocephalus (iNPH) is a disorder of elderly patients; it typically features ventriculomegaly, impaired gait, urinary incontinence and cognitive impairment . Although iNPH can be treated with shunting surgery , its status as a curable dementia has been questioned owing to varying outcomes of shunt replacement . The identification of comorbidities that may potentially hamper the efficacy of treatment has been considered vital in the clinical management of iNPH .…”

Secondary deterioration in patients with normal pressure hydrocephalus after ventriculoperitoneal shunt placement: a proposed algorithm of treatment

“…In our Department of Neurosurgery all patients with the suspected diagnosis iNPH were diagnosed using a published diagnostic pathway including an intrathecal infusion test and a CSF tap test [23]. A positive result in the invasive diagnostic method is defined as: (1) resistance to outflow (R out ) of 13 mmHg/min × mL or more in the lumbar CSF infusion test; (2) improvement of the performance of walking and turning by a minimum of 20% after spinal tap test.…”

“…The treatment of choice is ventriculoperitoneal (VP) shunt placement with adjustable valves [7] and about 74% of patients with iNPH benefit from VP shunting [22,23]. Studies with long term follow up of iNPH patients after shunting suggest, that a number of patients show delayed deterioration of their symptoms despite an improvement in the first months [23,24].…”

Idiopathic normal-pressure hydrocephalus

“…Ventriculoperitoneal shunts can improve symptoms, especially gait dysfunction, in up to 74% of patients. 4,5 Early treatment within 3 months of diagnosis is associated with better outcomes. 5 PRACTICE | FIVE THINGS TO KNOW ABOUT ...…”