Normal Pressure Hydrocephalus: A Reversible Late Side-Effect Of Whole Brain Radiation

Abstract

Describe the value to patients of ventriculoperitoneal (VP) shunting for normal pressure hydrocephalus (NPH) after receipt of whole brain radiation therapy (WBRT) for brain metastases. Patients who underwent WBRT at an NCI Comprehensive Cancer Center were retrospectively cross-matched to a list of patients who were subsequently diagnosed with, and underwent therapeutic VP shunt for NPH between January 1, 2016 and January 31, 2020. All patients were referred by a CNS specialist in radiation oncology to a neurosurgeon for clinical suspicion of NPH including new or progressive symptoms of magnetic gait (G), cognitive changes (C), and/or new onset of urinary incontinence (U). NPH was confirmed via large volume lumbar drain in all patients prior to shunting. Five patients were identified and constitute the subjects of this report. All patients were scored as either having (Y) or not (N) symptoms of G, C and U at diagnosis of NPH, and at post-shunting follow-ups. Time to any symptom failure or last follow-up was calculated. Median time from WBRT to presentation of symptoms suggesting NPH was 40 months (Range, 7-148m). The majority of patients were found to have improvement in all presenting symptoms. Patient 4 did not achieve improvement in cognitive impairment with VP shunt and patient 5 did not experience improvement in gait function after placement of VP shunt. Two patients were found to have durability of symptom improvement at the time of analysis. Three patients experienced relapse of symptoms after VP shunt placement with median time to failure being 2 months (Range, 1-8m). NPH is a potentially reversible side effect of WBRT. VP shunting may achieve complete or partial relief of symptoms in these patients and should be considered by clinicians in the follow-up of long-term survivors with cognitive, gait and urinary changes after WBRT.Abstract 3563; TableResponse to Shunting InterventionPatientWBRT to NPH Dx (Mos)Presenting NPH SxGaitCognitionUrinarySx at relapseTime to sx relapse (Mos)Follow-up without relapse (Mos)163G,C,UYYYNANA11237G,C,UYYYG,C8NA340G,C,UYYYNA447G,CYNNAG1NA5148C,UNANYCNA11NA = not applicable; Dx = Diagnosis Sx = Symptoms; Mos = months Open table in a new tab