There is little knowledge about the factors influencing the long-term outcome after surgery for idiopathic normal pressure hydrocephalus (iNPH).
To evaluate the effects of reoperation due to complications and of vascular comorbidity (hypertension, diabetes, stroke and heart disease) on the outcome in iNPH patients, 2–6 years after shunt surgery.
We included 979 patients from the Swedish Hydrocephalus Quality Registry (SHQR), operated on for iNPH during 2004–2011. The patients were followed yearly by mailed questionnaires, including a self-assessed modified Rankin Scale (smRS) and a subjective comparison between their present and their preoperative health condition. The replies were grouped according to the length of follow-up after surgery. Data on clinical evaluations, vascular comorbidity, and reoperations were extracted from the SHQR.
On the smRS, 40% (38–41) of the patients were improved 2–6 years after surgery and around 60% reported their general health condition to be better than preoperatively. Reoperation did not influence the outcome after 2–6 years. The presence of vascular comorbidity had no negative impact on the outcome after 2–6 years, assessed as improvement on the smRS or subjective improvement of the health condition, except after 6 years when patients with hypertension and a history of stroke showed a less favorable development on the smRS.
This registry-based study shows no negative impact of complications and only minor effects of vascular comorbidity on the long-term outcome in iNPH.
Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkelso C (2014) Prevalence of idiopathic normal-pressure hydrocephalus. Neurology 82(16):1449–1454. https://doi.org/10.1212/WNL.0000000000000342 CrossRefPubMedPubMedCentral
Klinge P, Hellstrom P, Tans J, Wikkelso C (2012) One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand. https://doi.org/10.1111/j.1600-0404.2012.01676.x
Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD, Gronseth G, Gloss D (2015) Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology 85(23):2063–2071. https://doi.org/10.1212/wnl.0000000000002193 CrossRefPubMedPubMedCentral
Kahlon B, Sjunnesson J, Rehncrona S (2007) Long-term outcome in patients with suspected normal pressure hydrocephalus. Neurosurgery 60(2):327–332. https://doi.org/10.1227/01.neu.0000249273.41569.6e CrossRefPubMed
Savolainen S, Hurskainen H, Paljarvi L, Alafuzoff I, Vapalahti M (2002) Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien) 144(6):515–523 (discussion 523) CrossRef
Mirzayan MJ, Luetjens G, Borremans JJ, Regel JP, Krauss JK (2010) Extended long-term (> 5 years) outcome of cerebrospinal fluid shunting in idiopathic normal pressure hydrocephalus. Neurosurgery 67(2):295–301. https://doi.org/10.1227/01.NEU.0000371972.74630.EC CrossRefPubMed
Mori K (2001) Management of idiopathic normal-pressure hydrocephalus: a multiinstitutional study conducted in Japan. J Neurosurg 95(6):970–973. https://doi.org/10.3171/jns.2001.95.6.0970 CrossRefPubMed
Illan-Gala I, Perez-Lucas J, Martin-Montes A, Manez-Miro J, Arpa J, Ruiz-Ares G (2015) Long-term outcomes of adult chronic idiopathic hydrocephalus treated with a ventriculo-peritoneal shunt. Neurologia (Barcelona, Spain). https://doi.org/10.1016/j.nrl.2015.10.002
Eide PK, Pripp AH (2014) Increased prevalence of cardiovascular disease in idiopathic normal pressure hydrocephalus patients compared to a population-based cohort from the HUNT3 survey. Fluids Barriers CNS 11(19):2045–8118
Jaraj D, Agerskov S, Rabiei K, Marlow T, Jensen C, Guo X, Kern S, Wikkelso C, Skoog I (2016) Vascular factors in suspected normal pressure hydrocephalus: a population-based study. Neurology 86(7):592–599. https://doi.org/10.1212/wnl.0000000000002369 CrossRefPubMedPubMedCentral
Israelsson H, Carlberg B, Wikkelso C, Laurell K, Kahlon B, Leijon G, Eklund A, Malm J (2017) Vascular risk factors in INPH: a prospective case-control study (the INPH-CRasH study). Neurology 88(6):577–585. https://doi.org/10.1212/wnl.0000000000003583 CrossRefPubMedPubMedCentral
Tullberg M, Jensen C, Ekholm S, Wikkelso C (2001) Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery. Am J Neuroradiol 22(9):1665–1673 PubMed
Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J (1999) Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg 90(2):221–226. https://doi.org/10.3171/jns.1999.90.2.0221 CrossRefPubMed
Malm J, Graff-Radford NR, Ishikawa M, Kristensen B, Leinonen V, Mori E, Owler BK, Tullberg M, Williams MA, Relkin NR (2013) Influence of comorbidities in idiopathic normal pressure hydrocephalus—research and clinical care. A report of the ISHCSF task force on comorbidities in INPH. Fluids Barriers CNS 10(1):22. https://doi.org/10.1186/2045-8118-10-22 CrossRefPubMedPubMedCentral
Sundstrom N, Malm J, Laurell K, Lundin F, Kahlon B, Cesarini KG, Leijon G, Wikkelso C (2017) Incidence and outcome of surgery for adult hydrocephalus patients in Sweden. Br J Neurosurg 31(1):21–27. https://doi.org/10.1080/02688697.2016.1229749 CrossRefPubMed
Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57(3 Suppl):S4–S16 (discussion ii–v) PubMed
Wardlaw JM, Smith C, Dichgans M (2013) Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol 12(5):483–497. https://doi.org/10.1016/s1474-4422(13)70060-7 CrossRefPubMed
Eide PK, Sorteberg W (2010) Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients. Neurosurgery 66(1):80–91. https://doi.org/10.1227/01.neu.0000363408.69856.b8 CrossRefPubMed
Ziegelitz D, Starck G, Kristiansen D, Jakobsson M, Hultenmo M, Mikkelsen IK, Hellstrom P, Tullberg M, Wikkelso C (2014) Cerebral perfusion measured by dynamic susceptibility contrast MRI is reduced in patients with idiopathic normal pressure hydrocephalus. J Magn Reson Imaging 39(6):1533–1542. https://doi.org/10.1002/jmri.24292 CrossRefPubMed
Ziegelitz D, Arvidsson J, Hellstrom P, Tullberg M, Wikkelso C, Starck G (2016) Pre-and postoperative cerebral blood flow changes in patients with idiopathic normal pressure hydrocephalus measured by computed tomography (CT)-perfusion. J Cereb Blood Flow Metab 36(10):1755–1766. https://doi.org/10.1177/0271678x15608521 CrossRefPubMed
Ziegelitz D, Arvidsson J, Hellstrom P, Tullberg M, Wikkelso C, Starck G (2015) In patients with idiopathic normal pressure hydrocephalus postoperative cerebral perfusion changes measured by dynamic susceptibility contrast magnetic resonance imaging correlate with clinical improvement. J Comput Assist Tomogr 39(4):531–540. https://doi.org/10.1097/RCT.0000000000000254 CrossRefPubMed
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