Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience
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ORIGINAL ARTICLE
Long term follow‑up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience Matheus Fernandes de Oliveira1,2 · A. A. Boa Sorte Jr.1 · D. L. Emerenciano1 · J. M. Rotta1 · G. A. S. Mendes1,2 · F. C. G. Pinto2 Received: 2 August 2020 / Accepted: 21 October 2020 © Belgian Neurological Society 2020
Abstract Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence and enlarged ventricular system due to disturbance of cerebrospinal fluid (CSF). This study aims to describe the long-term experience with patients with iNPH submitted to ventriculoperitoneal shunt (VPS) with the programmable valve STRATA® (Medtronic). We prospectively selected a cohort of patients with a diagnosis of iNPH from January 2010 to April 2013 in a Brazilian tertiary hospital. All patients underwent clinical evaluation, which consists of the Mini-Mental State Examination and Time Up and Go tests and the application of Japanese Scale for Idiopathic Normal Pressure Hydrocephalus in three stages: prior to the TT, 3 h after the TT and 72 h after the TT. Fifty patients were submitted to VPS and followed. There were 32 men and 18 women. Mean age was 77.1 with standard deviation of 10.9. Follow-up time ranged from 96 to 120 months, with mean of 106 months. After 1 year of follow-up, 42 (83%) patients presented with clinical improvement, decreasing to 62% of patients at mid-term follow-up and 38% of patients at late follow-up. Complications occurred in 18% of subjects, needing reoperation in 16%. Our results show relevant clinical impact of shunting in iNPH patients, decreasing over time. Complications should not be underestimated, reaching up to 18% and demanding reoperation in 16% of cases. Thus, although much has been improved with current shunt technology, it is still important to consider the drawbacks of treatment. Keywords Normal pressure hydrocephalus · Cerebrospinal fluid shunts · Treatment
Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence without causative disorders, as well as dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure and no secondary cause [1–10]. It is a differential diagnosis for most of the dementia and gait syndromes and occurs mainly in elderly populations [1–10].
* Matheus Fernandes de Oliveira [email protected] 1
Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, Av. Pedro de Toledo, 1800‑Vila Clementino, São Paulo, São Paulo, Brazil
Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
2
The known incidence is approximately 6 per 100,000 and it has a prevalence of 22 per 100,000 for suspected iNPH. There are associations with hypertension, cerebrovascular disease and Alzheimer disease [11–2
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