Article
Long-term follow-up after ventriculoperitoneal shunting in patients with idiopathic normal-pressure hydrocephalus
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Authors
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Jana Kohl
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg, Deutschland
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Boris A. Jöllenbeck
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg, Deutschland
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Imre Bondar
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg, Deutschland
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Raimund Firsching
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Choice of diagnostic methods and outcome after ventriculoperitoneal shunting in cases of suspected normal-pressure hydrocephalus still remains unclear. Therefore management differs from hospital to hospital. We analysed the outcome after shunting procedure in patients with idiopathic normal-pressure hydrocephalus treated between 2000 and 2007.
Methods: We analysed 51 cases of patients, who were operated on for idiopathic normal-pressure hydrocephalus (NPH) between 2000 and 2007. Candidates for shunting were identified by combination of clinical symptoms, MRI findings, neuropsychological profile, results of spinal tap test or lumbal drainage and/or intracranial pressure monitoring. Age ranged from 41 to 82 years, median70 years. Follow-up ranged from 0 to 8 years, median 2 years.
Results: 48 patients reported on an improvement of gait disturbance and 13 patients reported an improvement of the triad of gait disturbance, dementia and urinary incontinence.
In 13 cases improvement was documented for less than 1 year, but 7 of these patients underwent no further supervision. Improvement for 1, 2 and 3 years was documented in further 7 cases per year. 13 patients reported slight to moderate improvement and remaining residual symptoms of variable extent. In 22 cases secondary deterioration was noted after primary improvement. 5 patients suffered from subdural hematoma, three requiring further surgery. In 2 patients wound healing was protracted. 5 patients underwent no further supervision after 1 year, 6 patients after 2 and further 6 patients after 3 years. 22 patients felt ill with neurological/ psychiatric diseases in the run up to diagnosis of NPH. In cases of 14 other patients a neurological/ psychiatric disease was diagnosed or suspected during the postoperative course.
Conclusions: Over 90% of patients reported postoperative improvement of varying extent. In nearly 50% secondary deterioration was recorded after initial improvement. As patients with NPH are of older age, there is a high comorbidity with other diseases of the nervous system.
