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Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly
N R Graff-Radford1, J C Godersky, M P Jones
1Department of Neurology, University of Iowa College of Medicine, Iowa City.
Neurology
|December 1, 1989
Summary
Predicting surgical success in elderly patients with symptomatic hydrocephalus is possible. Key factors include CSF pressure patterns, cerebral blood flow ratios, dementia duration, and gait issues, aiding treatment decisions.
Area of Science:
- Neurosurgery
- Geriatrics
- Neurology
Background:
- Symptomatic hydrocephalus affects older adults, often necessitating surgical intervention.
- Predicting outcomes for shunt surgery in this demographic remains a clinical challenge.
Purpose of the Study:
- To identify predictors of shunt surgery success in elderly patients with symptomatic hydrocephalus.
- To evaluate the relationship between specific clinical and physiological variables and surgical outcomes.
Main Methods:
- Prospective study of 30 older patients undergoing shunt surgery for symptomatic hydrocephalus.
- Outcome assessment included gait analysis via videotaping, neuropsychological testing, and the Katz index of daily living.
- Statistical analysis employed univariate methods and the Fisher exact test.
Main Results:
- Twenty-three out of 30 patients showed improvement after surgery.
- Significant predictors of positive outcome included: time with B-waves on CSF pressure monitoring, anterior/posterior ratio in regional cerebral blood flow studies, duration of pre-existing dementia, and gait abnormality preceding dementia.
- Trends towards significance were observed for elevated CSF pressure and performance on the Multilingual Visual Naming Test.
Conclusions:
- Several pre-operative variables significantly correlate with shunt surgery outcomes in elderly patients with symptomatic hydrocephalus.
- These identified factors can assist clinicians in determining the appropriateness of surgical recommendations.