Idiopathic normal pressure hydrocephalus: results of a prospective cohort of 236 shunted patients.
OBJECTIVE
To describe the outcomes and complication rates in 236 patients with idiopathic normal pressure hydrocephalus (INPH) after treatment.


METHODS
Among a cohort of 257 patients with suspected INPH, 244 were shunted and 236 were followed up at 6 months after shunting (145 men [61.4%] and 91 women [38.6%] with a median age of 75 years). The study protocol of these patients included clinical, radiological, neuropsychological and functional assessment. The decision to shunt patients was based on continuous intracranial pressure monitoring and CSF dynamics studies. A differential low-pressure valve system, always combined with a gravity compensating device, was implanted in 99% of the patients.


RESULTS
After shunting, 89.9% of the patients showed clinical improvement (gait improved in 79.3% of patients, sphincter control in 82.4%, and dementia in 63.7%). Two patients (0.8%) died. Early postsurgical complications were found in 13 of the 244 shunted patients (5.3%). Six months after shunting, the follow-up CT showed asymptomatic hygromas in 8 of the 236 (3.4%). Additional postsurgical complications were found in 7 patients (3%), consisting of 6 subdural hematomas (3 acute and 3 chronic) and 1 distal catheter infection.


CONCLUSIONS
Currently, a high percentage of patients with INPH can improve after shunting, with early and late complication rates of less than 12%.
Department of Neurosurgery, Universitat Autònoma de Barcelona, Barcelona, Spain. pocama@neurotrauma.net
Maria Antonia
MA
Poca
Elisabeth
E
Solana
Francisco Ramón
FR
Martínez-Ricarte
Mónica
M
Romero
Dario
D
Gándara
Juan
J
Sahuquillo
D000368:Aged; D000369:Aged, 80 and over; D015170:Cerebrospinal Fluid Pressure; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology / Q000601:surgery*; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome