Predictors of favorable response to implanted of ventriculoperitoneal shunt in patients with idiopathic normal pressure hydrocephalus

Introduction: The indication of a ventriculoperitoneal shunt (VPS) is discussed in patients with idiopathic normal pressure hydrocephalus (iNPH), due to the heterogeneity of the response to treatment and the risks involved in neurosurgery. Objective: To search for clinical factors and complementary studies in order to determine predictors of a favorable response to the VPS placement in patients with iNPH. Methodology: A retrospective study of patients with probable iNPH (according to international guidelines) treated with VPS assisted in a neurological clinic from January 2014 to January 2017 was conducted. A univariate statisticalanalysis of the variables considered as possible prognostic factors was performed. Results: 58 patients were included. Women presented 3.68 times more chances of improvement after the VPS (p=0.019). Good response to the gait test was associated with better response to the VPS (p=0.024). Conclusions: Female sex and good response to the gait test could be considered as predictors of a favorable response to the VPS placement in patients with iNPH. A prospective study is necessary to achieve a homogeneous diagnostic evaluation and a more extensive longitudinal follow-up to evaluate the clinical evolution in this group of patients.

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Four-and-a-half-year Follow-up of Idiopathic Normal Pressure Hydrocephalus Patient Treated with a Ventriculoperitoneal Shunt

Journal of the Korean Neurological Association ◽

10.17340/jkna.2018.1.5 ◽

2018 ◽

Vol 36 (1) ◽

pp. 22-26

Author(s):

Junga Kwon ◽

Kyunghun Kang

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Normal Pressure Hydrocephalus Patient

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Outcomes of Ventriculoperitoneal Shunt in Patients With Idiopathic Normal-Pressure Hydrocephalus 2 Years After Surgery

Frontiers in Surgery ◽

10.3389/fsurg.2021.641561 ◽

2021 ◽

Vol 8 ◽

Author(s):

Abdul Malik Popal ◽

Zhoule Zhu ◽

Xinxia Guo ◽

Zhe Zheng ◽

Chengwei Cai ◽

...

Keyword(s):

Prognostic Factors ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Adverse Outcomes ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Shunt Surgery ◽

Vp Shunt ◽

Post Surgery ◽

Programmable Valve

Objective: To evaluate the outcomes and prognostic factors of ventriculoperitoneal shunts (VP-shunts) in patients with idiopathic normal-pressure hydrocephalus (iNPH) at 6 months and 2 years after surgery.Method: We retrospectively analyzed 68 patients admitted to our institute and diagnosed with probable iNPH from January 2017 to March 2021. All patients underwent VP-shunt surgery with a programmable valve, and their outcomes were assessed via the Krauss index and modified Rankin scale (mRS) at 6 months and 2 years post-surgery. Univariate and multivariate regression analysis was performed to identify the prognostic factors.Results: The mean age of the patients was 71.1 ± 8.4 (mean ± standard deviation) years. On the Krauss improvement index, 6-month follow-up results were available for 68 patients. Of these patients, 91.2% experienced attenuation of their preoperative symptoms, with a mean Krauss index of 0.58 ± 0.27, and 48 patients (70.6%) had a Krauss index ≥0.5. Two-year follow-up results were available for 33 patients; 90.9% of them had sustained improvement, with a Krauss index of 0.54 ± 0.31, and 21 patients (66.3%) had a Krauss index ≥0.5. Thirty-three patients (58%) were living independently after 2 years (mRS 0–2). The outcomes were worse for patients with multiple comorbidities. Neither an increased patient age nor a prolonged history of illness was statistically significant prognostic factors for adverse outcomes of VP-shunt surgery.Conclusion: Surgical treatment was well-tolerated by patients with iNPH who received VP-shunts. Most patients experienced attenuation of their preoperative symptoms. Multiple concurrent comorbidities should be considered as adverse prognostic factors before shunt insertion in patients with iNPH.

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Ventriculoperitoneal shunt in treating of idiopathic normal pressure hydrocephalus—single-center study

Acta Neurochirurgica ◽

10.1007/s00701-019-04135-5 ◽

2019 ◽

Vol 162 (1) ◽

pp. 1-7

Author(s):

David Krahulik ◽

Miroslav Vaverka ◽

Lumir Hrabalek ◽

Martin Hampl ◽

Matej Halaj ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Single Center ◽

Single Center Study ◽

Center Study

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Long-term 4 Years Follow-up Study of 482 Patients Who Underwent Shunting for Idiopathic Normal Pressure Hydrocephalus -Course of Symptoms and Shunt Efficacy Rates Compared by Age Group-

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2018-0318 ◽

2019 ◽

Vol 59 (7) ◽

pp. 281-286 ◽

Cited By ~ 3

Author(s):

Totaro TAKEUCHI ◽

Kozo YAJIMA

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Age Group ◽

Follow Up Study

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Ventriculoperitoneal Shunting of Idiopathic Normal Pressure Hydrocephalus Increases Midbrain Size: A Potential Mechanism for Gait Improvement

Neurosurgery ◽

10.1227/01.neu.0000232655.78335.d5 ◽

2006 ◽

Vol 59 (4) ◽

pp. 847-851 ◽

Cited By ~ 22

Author(s):

J Mocco ◽

Matthew I. Tomey ◽

Ricardo J. Komotar ◽

William J. Mack ◽

Steven J. Frucht ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Medical Center ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cross Sectional ◽

Mean Values ◽

Shunt Placement ◽

Ventriculoperitoneal Shunting ◽

The Mean

Abstract OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm2; postoperative mean, 6.90 ± 0.25 cm2; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

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