title: Comparison of outcomes between patients with idiopathic normal pressure hydrocephalus who received a primary versus a salvage shunt.
abstract: Placement of a ventriculoperitoneal (VP) shunt is the treatment of choice for communicating hydrocephalus; however, the extent to which VP shunting is able to relieve symptoms in patients who had previously been treated with cerebrospinal fluid diverting therapy at an outside institution remains unclear. A retrospective review of patients with idiopathic normal pressure hydrocephalus treated with VP shunts at a single institution between 1993 and 2013 was conducted. Patients were classified as having received a primary VP shunt if they had not been previously treated with a VP shunt, ventriculoatrial shunt, lumboperitoneal shunt, or endoscopic third ventriculostomy. Patients were classified as having received a salvage VP shunt if they had been previously treated by one of these four modalities at an outside institution prior to their presentation to our institution. There were 357 patients who received a primary shunt and 33 patients who received a salvage shunt. Patients who had a salvage shunt placed had significantly higher odds of requiring a future revision (54% versus 41%; odds ratio=2.85; 95% confidence interval [CI]: 1.24-6.57; p=0.014). Patients who received a salvage shunt had statistically significantly lower rates of gait improvement at 6months in comparison to patients who received a primary shunt (relative risk=0.35; 95% CI: 0.14-0.87; p=0.025). Despite these findings, there was no significant difference at last follow-up in improvement in gait, continence, and cognition, indicating that outcomes for patients requiring a salvage shunt were comparable to patients receiving a primary shunt.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Dane
authors.initials: D
authors.lastname: Moran
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Hung
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Sharif
authors.initials: S
authors.lastname: Vakili
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Hugo
authors.initials: H
authors.lastname: Fialho
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Jeon
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Jusué-Torres
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA. Electronic address: belder4@jhmi.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy
keywords: Normal pressure hydrocephalus; Reoperation; Shunt revision; Ventriculoperitoneal shunt