Outcome of Shunting in Idiopathic Normal-pressure Hydrocephalus and the Value of Outcome Assessment in Shunted Patients

Neurosurgery ◽  
2005 ◽  
Vol 57 (suppl_3) ◽  
pp. S2-40-S2-52 ◽  
Author(s):  
Petra Klinge ◽  
Anthony Marmarou ◽  
Marvin Bergsneider ◽  
Norman Relkin ◽  
Peter McL. Black
Keyword(s):  
Outcome Assessment ◽  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Long Term Results ◽  
Shunt Treatment ◽  
Criteria For Selection

Abstract OBJECTIVE: To develop guidelines for assessing shunt outcome in patients with idiopathic normal-pressure hydrocephalus (INPH). To date, the literature available on this topic has been marked by disparate definitions of clinical improvement, varying postoperative follow-up protocols and periods, and substantial differences in the postoperative management. Because specific criteria for defining clinical improvement are seldom reported, conclusions drawn about shunt outcome may be subjective. METHODS: A MEDLINE search back to 1966 was undertaken using the query NPH, normal-pressure hydrocephalus, shunting, shunt treatment, shunt response, outcome, and clinical outcome. The criteria for selection were studies that included INPH from 1966 to the present in which the outcome of INPH was reported in patient groups of 20 or more. RESULTS: To date, there is no standard for outcome assessment of shunt treatment in INPH. The variable improvement rates reported are not only because of different criteria for selection of patients but also because of different postoperative assessment procedures and follow-up intervals. CONCLUSION: Studies that have established fixed protocols for follow-up have shown that short- and long-term periods after shunting are determined by many factors. Whereas short-term results were more likely to be influenced by shunt-associated risks, long-term results were independent of factors inherent to the shunt procedure and shunt complications, i.e., death and morbidity related to concomitant cerebrovascular and vascular diseases. Studies have shown that beyond 1 year after surgery, these factors definitely influence the clinical effect of shunting, making the 1-year postshunt period a potential determinant of the shunt outcome. Guidelines for outcome assessment were developed on the basis of the available evidence and consensus of expert opinion.

Extended Long-Term (> 5 Years) Outcome of Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Mohammad Javad Mirzayan ◽  
Goetz Luetjens ◽  
Jan Juliaan Borremans ◽  
Jens Peter Regel ◽  
Joachim Kurt Krauss
Keyword(s):  
Cause Of Death ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Study Cohort ◽  
Long Term Follow Up ◽  
Improvement Index ◽  
Related Mortality

Abstract BACKGROUND Shunt surgery has been established as the only durable and effective treatment for idiopathic normal pressure hydrocephalus. OBJECTIVE We evaluated the “extended” long-term follow-up (> 5 years) in a prospective study cohort who underwent shunting between 1990 and 1995. A secondary objective was to determine the cause of death in these patients. METHODS Fifty-one patients were included after confirmation of the diagnosis by extensive clinical and diagnostic investigations. Surgery included ventriculoatrial or ventriculoperitoneal shunting with differential pressure valves in the majority of patients. For each of the cardinal symptoms, postoperative outcome was assessed separately with the Krauss Improvement Index, yielding a value between 0 (no benefit) and 1 (optimal benefit) for the overall outcome. RESULTS Mean age at surgery was 70.2 years (range, 50–87 years). Thirty patients were women, and 21 were men. Short-term (18.8 ± 16.6 months) follow-up was available for 50 patients. The Krauss Improvement Index was 0.66 ± 0.28. Long-term (80.9 ± 51.6 months) follow-up was available for 34 patients. The Krauss Improvement Index was 0.64 ±0.33. Twenty-nine patients died during the long-term follow-up at a mean age of 75.8 years (range, 55–95 years). The major causes of death were cardiovascular disorders: cardiac failure (n = 7) and cerebral ischemia (n = 12). Other causes were pneumonia (n = 2), acute respiratory distress syndrome (n = 1), pulmonary embolism (n = 1), cancer (n = 2), renal failure (n = 1), and unknown (n = 3). There was no shunt-related mortality. CONCLUSION Idiopathic normal pressure hydrocephalus patients may benefit from shunting over the long term when rigorous selection criteria are applied. Shunt-related mortality is negligible. The main cause of death is vascular comorbidity.

scholarly journals Long term prognosis of ventriculoatrial shunt for idiopathic normal pressure hydrocephalus in the elderly

2017 ◽  
Vol 31 (4) ◽  
pp. 490-494
Author(s):  
Tsukasa Kawase ◽  
Kyosuke Miyatani ◽  
Riki Tanaka ◽  
Yasuhiro Yamada ◽  
Shamim Ul Haq Siddiqui ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Modified Rankin Scale ◽  
Shunt Insertion ◽  
Significant Difference ◽  
Long Term Prognosis

Abstract Objective: A retrospective study was conducted to access the long-term prognosis of inserting the Ventriculoatrial (VA) shunt in the elderly for the idiopathic normal pressure hydrocephalus (iNPH). Material and Methods: Retrospective data is collected from April 2004 to August 2015, and 1065 patients were selected. Patients who underwent surgical examination or surgery in suspected iNPH were included. Tap test is done in all cases and found to be effective for 968 cases and 656 VA shunts for 614 cases. Out of 614 cases there are 440 cases in which patient age were over 75 years. Of these 440 cases only 141 cases were able to observe 03 years or more after the surgery, 37 deaths and 05 cases with survival and unknown prognosis were found among them. So we analyzed this group mainly in 99 cases that the prognosis after 03 years was known. We access the outcome of VA shunt by the modified Rankin scale (mRS), iNPH grading scale (iNPHGS) and complications in the operative 656 cases and in 03 years follow up of 141 patients. Results: Of 141, there are 78 males and 63 females. Age at the time of VA shunt insertion was 81.5±4.1 years and age at final follow-up was 85.2±4.4 years. The proportion of patients who achieved a favorable outcome by complications was 97.9% in 03 years follow-up period and 87.7% in which follow-up is less than 03 years. At the time of VA shunt insertion out of 141, 57 patients lies between 75-79 years, 57 between 80-84, 24 between 85 to 89, and only 03 were found to be 90 years or more. At the time of final follow-up at 03 years, 15 patients lies between 75 to 79 years, 56 between 80 to 84 years, 57 between 85 to 89 years and 23 patents were found to be 90 years or greater. 70 cases or almost 50% exceeded 85 years. At the time of VA shunt 1, 11, 39, 51, 36, 3, 0 patients were in 0 to 6 modified Rankin Scale Score respectively and at 03 years follow-up 8, 19, 32, 29, 9, 2, 37 were in 0 to 6 mRS respectively. Comparison of the study is done with SIPHONI study on VP shunt and LP shunt. Conclusion: Patients suspected of having idiopathic normal pressure hydrocephalus were treated by VA shunt and found no significant difference in serious adverse effects. This study shows that VA shunt is an effective choice for iNPH in the late elderly population, but it needs more randomized control trial to establish its efficacy.

Normal Pressure Hydrocephalus in a Patient with Myotonic Dystrophy: Case Report with a 10-Year Follow-up

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. E796-E796 ◽  
Author(s):  
Maxime Delavallée ◽  
Christian Raftopoulos
Keyword(s):  
Myotonic Dystrophy ◽  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Clinical Feature ◽  
Long Term Memory ◽  
Complete Evaluation

Abstract OBJECTIVE AND IMPORTANCE: Myotonic dystrophy (MD) is the most common adult muscular dystrophy involving multiple organs. Normal pressure hydrocephalus (NPH) is characterized by gait apraxia, urinary incontinence, and dementia. NPH in association with MD has been reported in only three cases. This report provides for the first time the complete evaluation, treatment, and long-term follow-up of a patient with NPH and MD. CLINICAL PRESENTATION: A 61-year-old man known to have MD complained of 4 years of progressive deterioration of long-term memory and gait disturbance, which was the main clinical feature. Computed tomography scan and magnetic resonance imaging showed ventricular enlargement. Intracranial pressure monitoring showed B waves with amplitude superior to 9 mm Hg in more than 5% of the recording. TECHNIQUE: We performed a ventriculoperitoneal shunt with clear postoperative improvement, confirming the diagnosis of NPH. The clinical improvement has remained stable through prolonged follow-up. CONCLUSION: Association between MD and NPH could be more than coincidental, and it is important to recognize this potential insidious association because a ventriculoperitoneal shunt can provide excellent long-term clinical improvement.

scholarly journals Epilepsy, headache, and abdominal pain after shunt surgery for idiopathic normal pressure hydrocephalus: the INPH-CRasH study

2018 ◽  
Vol 128 (6) ◽  
pp. 1674-1683 ◽  
Author(s):  
Jenny Larsson ◽  
Hanna Israelsson ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Virtual Surgery ◽  
Shunt Surgery ◽  
Long Term Follow Up

OBJECTIVEAdverse events related to shunt surgery are common and might have a negative effect on outcome in patients with idiopathic normal pressure hydrocephalus (INPH). The authors’ objectives were to establish the frequencies of epilepsy, headache, and abdominal pain and determine their impact on patient quality of life (QOL), in long-term follow-up after shunt surgery for INPH.METHODSOne hundred seventy-six shunt-treated patients with INPH (mean age 74 years) and 368 age- and sex-matched controls from the population were included. The mean follow-up time after surgery was 21 months (range 6–45 months). Each participant answered a questionnaire regarding present frequency and severity of headache and abdominal pain. Confirmed diagnoses of epilepsy and all prescriptions for antiepileptic drugs (AEDs) before and after shunt surgery for INPH were gathered from national registries. Equivalent presurgical and postsurgical time periods were constructed for the controls based on the date of surgery (the division date for controls is referred to as virtual surgery). All registry data covered a mean period of 6 years (range 3–8 years) before surgery/virtual surgery and 4 years (range 2–6 years) after surgery/virtual surgery. Provoked epileptic seizures were excluded. Patient QOL was assessed with the EuroQoL 5-dimension 5-level instrument.RESULTSEpilepsy was more common in shunt-treated patients with INPH than in controls (4.5% vs 1.1%, respectively; p = 0.023), as was treatment with AEDs (14.8% vs 7.3%, respectively; p = 0.010). No difference was found between the populations before surgery/virtual surgery (epilepsy, 2.3% [INPH] vs 1.1% [control], p = 0.280; AED treatment, 8.5% [INPH] vs 5.4% [control], p = 0.235). New-onset epilepsy and new AED treatment after surgery/virtual surgery were more common in INPH (epilepsy, 2.3% [INPH] vs 0.0% [control], p = 0.011; AED, 8.5% [INPH] vs 3.3% [control], p = 0.015). At follow-up, more patients with INPH than controls experienced headache several times per month or more often (36.1% vs 11.6%, respectively; p < 0.001). Patients with INPH and unilateral headache had more right-sided headaches than controls (p = 0.038). Postural headache was experienced by 16% (n = 27 of 169) of the patients with INPH. Twenty percent (n = 35) of the patients with INPH had persistent abdominal pain. Headache was not correlated to lower QOL. The study was underpowered to draw conclusions regarding QOL in patients with INPH who had epilepsy and abdominal pain, but the finding of no net difference in mean QOL indicates that no correlation between them existed.CONCLUSIONSEpilepsy, headache, and abdominal pain are common in long-term follow-up in patients after shunt surgery for INPH and are more common among patients with INPH than in the general population. All adverse events, including mild and moderate ones, should be considered during postoperative follow-ups and in the development of new methods for shunt placement.

scholarly journals Manajemen Perioperatif Gejala Ekstrapiramidal (EPS) pada Hidrocephalus Tekanan Normal (NPH)

2020 ◽  
Vol 9 (2) ◽  
pp. 183-190
Author(s):  
Agus Baratha Suyasa ◽  
◽  
Ni Putu Dharmi Lestari ◽  
Keyword(s):  
Dopamine Receptor ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Extrapyramidal Symptoms ◽  
Medical Rehabilitation ◽  
Long Term Results ◽  
Shunt Operation ◽  
Receptor Blocking

Extrapyramidal symptoms (EPS) are movement disorders due to side effects of dopamine receptor blocking agents. Symptoms of EPS include dystonia, akathisia, and parkinsonism. Symptoms of EPS in this case are found in normal pressure hydrocephalus (NPH) which does not consume dopamine receptor blocking drugs. Normal pressure hydrocephalus is hydrocephalus which does not coincide with intracranial pressure (ICT) elevation. Reported a case of a 57-year-old male with decreased consciousness and extrapyramidal symptoms and Normo pressure hydrocephalus (NPH), a V-P Shunt operation was performed. The operation was carried out under general anesthesia, using a non-kinking ETT no. 7.5, controlled ventilation. Premedication given midazolam 2 mg iv, Co induction with oxycodon 10 mg iv. Induction with propofol 150 mg iv, intubation facilities with rocketuronium 30 mg iv, maintenance with O2: Air (50: 50), sevoflurane, propofol continuous 100 mg/hour, rokuronium 20 mg/hour. Stable hemodynamics, SBP 130–150 mmHg, DBP 80–90 mmHg, HR 50–70 x/min, O2 saturation 99–100%, etCO2 35–37. After surgery the patient was treated in the intensive care unit (ICU) for monitoring blood pressure and extrapyramidal symptoms. The main goal of treatment should not be solely for the treatment of acute symptoms of EPS but also for the management of basic disease causing EPS related to morbidity and maintaining quality of life. Multidisciplinary management (neurosurgery, neurosurgery, intensive anesthesia and medical rehabilitation) are needed for better long-term results.

DIAGNOSIS, TREATMENT, AND ANALYSIS OF LONG-TERM OUTCOMES IN IDIOPATHIC NORMAL-PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_2) ◽  
pp. 699-705 ◽  
Author(s):  
Matthew J. McGirt ◽  
Graeme Woodworth ◽  
Alexander L. Coon ◽  
George Thomas ◽  
Michael A. Williams ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Long Term Outcomes
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