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Long-Term Follow-up in Idiopathic Normal Pressure Hydrocephalus-Towards a more Comprehensive Disease Outcome
Flurina Kuser1, Sandra Fernandes Dias2, Lennart Henning Stieglitz1
1Department of Neurosurgery and Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
World Neurosurgery
|October 8, 2025
Summary
Shunt therapy significantly improves idiopathic normal pressure hydrocephalus (iNPH) symptoms for up to six years. Patients experienced better gait, cognition, and continence after surgery.
Area of Science:
- Neurosurgery
- Neurology
- Geriatrics
Background:
- Idiopathic normal pressure hydrocephalus (iNPH) presents with gait disorder, cognitive decline, and urinary incontinence.
- Characterized by ventricular dilation and normal intracranial pressure, iNPH requires effective long-term management strategies.
Purpose of the Study:
- To evaluate the long-term efficacy of shunt implantation in patients with iNPH.
- Assess outcomes up to six years post-surgery for gait, cognition, and urinary function.
Main Methods:
- Retrospective review of 165 iNPH patients undergoing shunt surgery.
- Outcomes measured using Kiefer Scale, NPH-Recovery Rate (NPH-RR), gait analysis (180° turn steps), MoCA scores, and urinary continence status.
Main Results:
- Significant improvement in Kiefer Scores observed up to 6 years post-shunting (P < 0.001).
- NPH-RR indicated good clinical outcome in the first 3 years.
- Reduced steps for 180° turn (4.4 to 2.8), improved MoCA scores in 32.1% of tested patients, and decreased urinary incontinence from 70.4% to 29.6%.
Conclusions:
- Shunt therapy provides significant, sustained benefits for iNPH patients up to 6 years postoperatively.
- Improvements span all key clinical triad components: gait, cognition, and urinary continence.
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