Treatment for secondary deterioration in idiopathic normal pressure hydrocephalus in the later course of the disease: a
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ORIGINAL ARTICLE - CSF CIRCULATION
Treatment for secondary deterioration in idiopathic normal pressure hydrocephalus in the later course of the disease: a retrospective analysis Stefanie Kaestner 1,2
&
Rhea Behrends 2 & Christian Roth 3 & Katharina Graf 4 & Wolfgang Deinsberger 1,2
Received: 14 April 2020 / Accepted: 24 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Summary Background Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration. Methods A retrospective analysis was conducted on all patients with iNPH who were treated with implantation of a CSF shunt since 1993. A meticulous shunt workup was recommended to all patients who presented to our department with secondary deterioration during their follow-up visits. Data about the proportion of patients with such deterioration and its causes, subsequent treatment, and clinical outcome were obtained. Results A total of 169 patients were included, and the mean follow-up time was 69.2 months. In total, 119 (70.4%) patients presented with a total of 153 secondary deteriorations. In 9 cases (5.9%), the deterioration was caused by delayed subdural hematoma and in 27 (22.1%) cases, by shunt dysfunction. Invasive shunt testing was commonly required to validate shunt failure. Moreover, 19 of 27 patients experienced a satisfactory improvement after revision surgery. In total, 86 deteriorations were attributed to nonsurgical causes, and the valve pressure was decreased in 79 patients, with only 16.5% presenting with a satisfactory improvement after lowering of valve pressure. Conclusions Most patients with shunted iNPH presented with deterioration in the later course of the disease. Shunt dysfunction was considered a cause of secondary deterioration. Moreover, shunt revision surgery was a highly effective treatment, and patients with deterioration should undergo screening procedures for shunt dysfunction, including invasive shunt testing. Keywords Idiopathic normal pressure hydrocephalus . Long-term, secondary deterioration . Natural course . Shunt revision surgery
Introduction This article is part of the Topical Collection on CSF Circulation * Stefanie Kaestner [email protected] 1
Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125 Kassel, Germany
2
Kassel School of Medicine, University of Southampton, 12 University Rd, Southampton SO17 1BJ, UK
3
Department of Neurology, Red Cross Clinic, Hanstein Str. 29, 34121 Kassel, Germany
4
Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstraße 29, 35392 Giessen, Germany
Idiopathic normal pressure hydrocephalus (iNPH) is a condition of the central nervous system that is characterized by enlarged ventricles and Hakim’s triad (gait disturbances, incontinence, and dementia), commonly affecting elderly individuals. Its incidence h
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