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Protocolizing the Workup for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes.

Lealani Mae Y Acosta1, Kassandra Stubblefield1, Trisha Conwell1

  • 1Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.

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Summary

A new protocol for idiopathic normal pressure hydrocephalus (INPH) improves patient selection for shunting. This leads to better gait outcomes in patients receiving ventriculoperitoneal shunts.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Clinical Protocol Development

Background:

  • Idiopathic normal pressure hydrocephalus (INPH) diagnosis and shunting candidate selection are challenging.
  • Current workup coordination for INPH can be difficult.
  • A formalized protocol may enhance patient selection for ventriculoperitoneal shunting.

Purpose of the Study:

  • To evaluate the impact of a standardized INPH assessment protocol on patient selection and outcomes.
  • To compare the effectiveness of a new protocol versus pre-protocol (PP) patient management.
  • To determine if protocol implementation improves outcomes related to shunting.

Main Methods:

  • A cohort of 40 patients managed under a new INPH protocol was compared to 26 patients managed pre-protocol.
  • Key measures included baseline deficits, diagnostic workup (e.g., high-volume lumbar puncture, gait/cognitive assessments), neurosurgical evaluation, and shunt response.
  • Statistical analysis was used to compare outcomes between the two groups.

Main Results:

  • Protocol patients underwent significantly more high-volume lumbar punctures (HVLP), formalized gait assessments, and standardized cognitive testing.
  • A higher percentage of protocol patients showed no improvement after HVLP, leading to fewer receiving shunts.
  • While shunt recipients in the protocol group showed improved gait, cognitive and incontinence improvements were not significantly different compared to the pre-protocol group.

Conclusions:

  • Implementation of an INPH protocol standardizes and expands patient assessment.
  • The protocol improves patient selection for shunting, particularly for gait-related symptoms.
  • Enhanced assessment under the protocol leads to better outcomes from ventriculoperitoneal shunting.