The efficacy of laparoscope-assisted ventriculoperitoneal shunt in treatment of idiopathic normal pressure hydrocephalus in elder patients

Abstract

Objective To investigate the clinical efficacy of laparoscope-assisted ventricu-loperitoneal(VP) shunt in treatment of idiopathic normal pressure hydrocephalus (iNPH) in elder patients. Methods From January 2015 to January 2018, a total of 78 elder patients(60 to 89 years old) with iNPH were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University. Those patients were retrospectively analyzed and divided into 2 groups with 39 cases in each group: traditional surgical group (control group) and laparoscope-assisted operation group (treatment group). Traditional VP shunt was conducted in the control group and laparoscope-assisted VP shunt in treatment group. We compared the effectiveness in the 2 groups, pre- and postoperative activity of daily living (ADL) scores, classifications of iNPH, Evan's indexes as well as Callosal angles, incidences of postoperative complications. Results There were statistically significant differences in average hospitalization time, time of ambulation, average operating hours between the treatment group [(10.5±2.3) d, (3.2±1.3) d, (63.2±10.5) min, respectively] and the control group [(19.8±3.6) d, (6.1±2.1) d, (82.4±11.4) min, respectively] (all P 0.05). The incidence of shunt obstruction, postoperative infection rate, gastrointestinal symptoms, intracranial hypopressure syndrome, abdominal organ injury and cerebral hemorrhage in the treatment group were significantly lower than those in the control group, though these was no statistically significant differences between 2 groups (all P>0.05). The incidence of overall complications was lower in treatment group (33.3%, 13/39) than in control group (89.7%, 35/39) (P<0.001). The total effective rate of treatment group patients (89.7%) was significantly higher than that in control group (69.2%) (P<0.05). Conclusion Compared with the traditional VP shunt, laparoscope-assisted VP Shunt used for treatment of iNPH of elderly patients has significant curative effect, and the location of the catheter is accurate which could effectively prevent the total occurrence of postoperative complications and improve the clinical symptoms and outcome of elderly patients to certain degrees. Key words: Hydrocephalus, normal pressure; Aged; Laparoscope; Ventriculoperito-neal shunt