Long-Term Efficacy of Shunt Therapy in Idiopathic Normal Pressure Hydrocephalus.

Abstract

BACKGROUND:

Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves.

METHODS:

Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least 10 years.

RESULTS:

Among 50 patients treated, 5 had died at the time of the evaluation. Median age was 71 years, and mean follow-up time of the surviving patients was 120.2 ± 2.3 years. Overall, there was a significant and lasting improvement among all symptoms compared with the baseline (P < 0.05). Gait showed better and sustained improvement compared with the baseline (P < 0.05). Cognitive impairment and urinary incontinence improved in the early follow-up (P < 0.05) followed by declines in long-term follow-up. Ten patients (20%) required surgical revisions for shunt malfunction. Change in valve pressure was performed in 20 patients (40%). Overall, 93.3% revisions resulted in clinical improvement.

CONCLUSIONS:

Surgical treatment for idiopathic normal pressure hydrocephalus by ventriculoperitoneal shunt is a safe modality that improves symptoms in most patients, including in the long-term. Strict follow-up is necessary for early diagnosis of shunt malfunction or need for valve adjustment.

• Authors: Giovanni Grasso, Fabio Torregrossa, Ludovica Leone, Antonino Frisella, Alessandro Landi
• Journal: World neurosurgery (World Neurosurg) Vol. 129 Pg. e458-e463 (Sep 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 31154105 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Cognitive Dysfunction (etiology)
• Female
• Follow-Up Studies
• Humans
• Hydrocephalus, Normal Pressure (surgery)
• Male
• Middle Aged
• Treatment Outcome
• Ventriculoperitoneal Shunt (adverse effects, methods)