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Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality

Kerstin Andrén1, Carsten Wikkelsö2, Nina Sundström3

  • 1Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden. kerstin.andren@neuro.gu.se.

Journal of Neurology
|December 1, 2017
PubMed

Insights

Long-term outcomes for idiopathic normal pressure hydrocephalus (iNPH) surgery are generally positive. Complications and vascular issues rarely impact results, though some stroke patients may see less benefit after six years.

Area of Science:

  • Neurosurgery
  • Neurology
  • Clinical Outcomes Research

Background:

  • Limited understanding of factors affecting long-term outcomes following idiopathic normal pressure hydrocephalus (iNPH) surgery.
  • Need to assess the influence of reoperations and vascular comorbidities on shunt surgery success in iNPH patients.

Purpose of the Study:

  • To evaluate the long-term (2-6 years) effects of reoperation due to complications on iNPH patient outcomes.
  • To assess the impact of vascular comorbidity (hypertension, diabetes, stroke, heart disease) on iNPH patient outcomes post-shunt surgery.

Main Methods:

  • Analysis of 979 iNPH patients from the Swedish Hydrocephalus Quality Registry (SHQR) operated on between 2004-2011.
  • Yearly follow-up using mailed questionnaires assessing self-modified Rankin Scale (smRS) and subjective health improvement.
  • Data extraction on clinical evaluations, vascular comorbidities, and reoperations from the SHQR.

Main Results:

  • 40% of iNPH patients showed improvement on the smRS, and 60% reported better general health 2-6 years post-surgery.
  • Reoperations did not significantly influence long-term outcomes (2-6 years).
  • Vascular comorbidity generally had no negative impact, except for hypertension and stroke history patients showing less favorable smRS development at 6 years.

Conclusions:

  • Complications requiring reoperation do not negatively impact the long-term outcome of iNPH shunt surgery.
  • Vascular comorbidity has minimal negative effects on long-term iNPH outcomes, with slight exceptions noted at the 6-year mark for specific conditions.
Abstract

Keywords:
ComplicationsConcomitant diseaseDementiaGaitHydrocephalusNormal pressureRegistriesRisk factors

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