Abstract
BackgroundPermanent cerebrospinal fluid (CSF) diversion with a ventriculoperitoneal shunt (VPS) is a treatment option for patients with normal pressure hydrocephalus (NPH).ObjectivesHerein, we examine the outcomes, complication rates, and associations between predictors and outcomes after VPS in patients with NPH.MethodsThis was a retrospective review of 116 patients (68 males, 48 females) with NPH who underwent VPS placement from March 2008 to September 2017 after demonstrating objective and/or subjective improvement after a lumbar drain trial. The Chi-square test of independence was used to examine associations between predictors and clinical improvement after shunting. Complications associated with the VPS procedure were recorded.ResultsThe mean age was 77 years (range 52-93). The mean duration of disturbance in gait, cognition, and continence were 29, 32, and 28 months, respectively. Of the 116 patients, 111 followed up at two weeks; of these, improvement in gait, incontinence, and cognition were reported in 72, 20, and 23 patients, respectively. Gait improved more than incontinence or cognition. A shorter duration of gait disturbance predicted an improvement in gait after shunting (p<0.01). Being on a cognition-enhancing medication predicted an improvement in cognition and/or incontinence after shunting (p<0.05). Complications included misplaced proximal catheters (n=6), asymptomatic catheter tract hemorrhages (n=3), bilateral hygromas (n=7), subdural hematomas (SDH) (n=5), and CSF leak (n=1).ConclusionVPS placement in patients with NPH is well-tolerated and associated with improved outcomes at least in the short-term follow-up (<6 months). A shorter duration of gait disturbance and being on a cognition-enhancing medication are associated with greater improvement after VPS.
Highlights
Normal pressure hydrocephalus (NPH) affects 0.5% to 2.9% of elderly patients [1]
We examine the outcomes, complication rates, and associations between predictors and outcomes after ventriculoperitoneal shunt (VPS) in patients with normal pressure hydrocephalus (NPH). This was a retrospective review of 116 patients (68 males, 48 females) with NPH who underwent VPS placement from March 2008 to September 2017 after demonstrating objective and/or subjective improvement after a lumbar drain trial
When a potential diagnosis of NPH is made, a large-volume lumbar tap or a short-term lumbar drain (LD) trial is usually performed to assess the potential response to the cerebrospinal fluid (CSF) diversion
Summary
Normal pressure hydrocephalus (NPH) affects 0.5% to 2.9% of elderly patients [1]. Typically, patients present with at least two of the following: gait disturbance, cognitive decline, and urinary incontinence, in addition to ventricular enlargement [2]. A permanent CSF diversion with a ventriculoperitoneal shunt (VPS) is a treatment option for patients with NPH. There is no test that can predict with certainty which patients will experience sustained benefit from shunting; studies to identify factors that can reliably predict shunt outcomes have been conducted [5,6,7]. The results of such studies, remain controversial. Permanent cerebrospinal fluid (CSF) diversion with a ventriculoperitoneal shunt (VPS) is a treatment option for patients with normal pressure hydrocephalus (NPH)
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