title: Long-term outcomes of adult chronic idiopathic hydrocephalus treated with a ventriculo-peritoneal shunt.
abstract: BACKGROUND
  Adult chronic idiopathic hydrocephalus (ACIH) is a cause of dementia that can be treated by implanting a ventriculo-peritoneal shunt (VPS). We aim to study clinical and functional outcomes in patients with ACIH corrected with a VPS.
  
  
  METHODS
  Observational cohort study of patients diagnosed with probable ACIH (Japan Neurosurgical Society guidelines) and undergoing shunt placement between 2008 and 2013 in a centre of reference for neurosurgery in Spain. Clinical improvement was classified in 4 categories (resolution, partial improvement, equivocal improvement, and no improvement); functional outcome was assessed on the modified Rankin scale (mRS).
  
  
  RESULTS
  The study included 29 patients with a mean age of 73.9 years; 62.1% were male and 65.5% had hypertension. Clinical improvement (complete or partial) was observed in 58% after one year and in 48% by the end of the follow-up period (mean follow-up time was 37.8 months). Older age, presence of hypertension, and surgery-related complications were more prevalent in the group responding poorly to treatment. One patient died, 20.7% experienced severe complications, and 69% were dependent (mRS ≥ 3) by the end of the follow-up period. Age at diagnosis was independently associated with poorer clinical response at one year and a higher degree of dependency by the end of follow-up.
  
  
  CONCLUSIONS
  Symptomatic benefits offered by VPS were partial and transient; treatment was associated with a high complication rate and poor functional outcomes in the long term, especially in the oldest patients.
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España. Electronic address: ignacio.illan@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Illán-Gala
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Pérez-Lucas
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Martín-Montes
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Máñez-Miró
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Arpa
authors.affiliation: Servicio de Neurología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Ares
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery*; D006973:Hypertension / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: Chronic adult hydrocephalus; Derivación ventrículo-peritoneal; Epidemiology; Epidemiología; Hidrocefalia crónica del adulto; Hidrocefalia normotensiva; Normal pressure hydrocephalus; Tratamiento; Treatment; Ventriculo-peritoneal shunt