Does Idiopathic Normal Pressure Hydrocephalus Always Mean a Poor Prognosis?
The objective was to assess whether idiopathic normal-pressure hydrocephalus (iNPH) has a worse prognosis than other forms of hydrocephalus, as has been suggested.
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Abstract Objective The objective was to assess whether idiopathic normal-pressure hydrocephalus (iNPH) has a worse prognosis than other forms of hydrocephalus, as has been suggested. Methods A total of 125 patients with chronic hydrocephalus, 75 of whom suffered from iNPH and the remaining (non-INPH) from sNPH or non-communicating hydrocephalus, were shunted using gravitational valves. Clinical state was assessed with our clinical grading (KI) and a co-morbidity index (CMI). Average follow-up was 5.1 ± 1.6 years. Statistics: Spearman, Kruskal–Wallis, ANOVA, c2- and the Wilcoxon U tests at a significance level of p < 0.05 were used. Results Shunt responder rates for iNPH and non-iNPH were 72% and 86%, respectively. With shorter anamnesis (£1 year) or preoperative KI < 6 points, iNPH patients had a similar or even better outcome than non-iNPH patients with longer anamnesis or a worse KI. Most impressive was the influence of co-morbidity: 86% of iNPH patients with a low CMI (£3 points) experienced clinical improvement after shunting, which was contrasted by a responder rate of 64% for non-iNPH with worse CMI. Conclusion The diagnosis of iNPH does not by itself mean a worse prognosis, and iNPH patients with favorable preconditions may have a similar or better prognosis than patients with any other kind of hydrocephalus. The worse overall clinical results of iNPH result from late recognition and in most instances worse preconditions. Keywords Hydrocephalus • shunt • clinical results • outcome • co-morbidity • normal pressure hydrocephalus • iNPH M. Kiefer () Department of Neurosurgery, Saarland University Medical School, Kirrberger Str., Building: 90.1, Homburg-Saar 66421, Germany e-mail: [email protected] R. Eymann Department of Neurosurgery, Medical School, Saarland University, Kirrberger Street, Building 90, Homburg-Saar, Saarland 66421, Germany
Introduction Idiopathic normal pressure hydrocephalus (iNPH) is typically thought to have a worse prognosis than other forms of chronic hydrocephalus (3,6,14). Other forms of chronic hydrocephalus (non-iNPH) such as secondary normal pressure hydrocephalus or non-communicating hydrocephalus were found to respond to shunting 74% and 87% percent of the time, respectively (3,6,9,14). In contrast, the provided responder rates in iNPH seldom exceed 50% (3,6,12,14), leading to the question of whether risk-benefit analysis would not argue against iNPH shunting (14). On closer inspection, however, iNPH patients should typically be older, are diagnosed later and should have more severe co-morbidity compared with patients with sNPH or non-communicating hydrocephalus. We have recently found that the clinical state and co-morbidity prior to shunting are important predictors of outcome (10). Worse preconditions may significantly contribute to worse outcomes for iNPH. The aim of this prospective study was to analyze whether iNPH might have a similar prognosis as non-iNPH if iNPH patients are in the good clinical precondition, which is typically the norm for non-iNPH hydrocephalu
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