Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study.
Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.
Raftopoulos
C
C
Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium.
Deleval
J
J
Chaskis
C
C
Leonard
A
A
Cantraine
F
F
Desmyttere
F
F
Clarysse
S
S
Brotchi
J
J
D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000175:diagnosis / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies