Related Experiment Video
Updated: Sep 2, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Quantitative gait analysis value as a predictor of shunt surgery effectiveness in normal pressure hydrocephalus: A
Miguel F Gago1, Flora Ferreira2, Estela Bicho3
1Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.
Introduction:
Shunt surgery (SS) remains the most effective treatment for idiopathic Normal pressure hydrocephalus (iNPH), but the selection of the patients with the greatest potential benefit remains elusive.
Objective:
Identify gait features predictive of best response to SS in iNPH.
Methods:
Eight patients with iNPH were assessed at baseline, after Cerebrospinal fluid tap-test (CSF-TT) and SS, with clinical scales (Clinical/Patient Global Clinical Impression, EuroQol-5D, Clinical Dementia Rating Scale(CDR), MoCA test, Hoehn-Yahr Scale) and gait analysis with inertial sensors.
Results:
The 8 included iNPH patients had a mean age of 73 years(59-81), moderate cognitive (CDR-1.5 (0.5-2); MoCA-9.5 (3-21)) and motor impairment (Hoehn-Yahr-2.75(2-3)). After SS, patients had a significant improvement in cognition (MoCA, p = 0.001) and quality of life. At baseline, patients with lower improvement (no change/ minimally improved) (n = 2), in comparison to patient with higher improvement (much/very much improved) (n = 6), already had higher cognitive impairment (MoCa-3(3-3) vs. 11(7-21)). Patients with lower improvement had a lower % of change in gait performance at LP (mean 10.2 %) and were absent of additional benefit after SS(mean -0.8 %). In contrast, gait performance in patients with higher improvement consistently got better from baseline to LP (mean 23.1 %) and from baseline to SS (mean 82.9 %). A significant negative correlation was observed between CDR score and several gait variables: speed (rpb=-0.92,p = 0.009); stride length (rpb=-0.92,p = 0.009); lift-off angle (rpb=-0.96,p = 0.003); and maximum heel (rpb=-0.81,p = 0.049).
Conclusion:
The magnitude of gait improvement after CSF-TT, quantified by gait analysis, can be used as an integral variable in the multimodal clinical approach to the prediction of improvement after SS.
