gms | German Medical Science

Objective: This study was conducted to evaluate the short-term clinical course and possible complications of shunting procedures in patients with normal pressure hydrocephalus (NPH).

Methods: 629 patients were screened who presented with hydrocephalus during the ten years interval between 2002 and 2012 and 80 patients (male 47, female 33; mean age 71.1 years) with NPH were included in the study. We reviewed the charts for the utilized hardware, neurological performance pre- and postoperatively according to the Medical Research Council Neurological Performance Score (MRC-NPS), re-operations and valve-adjustments in short-term course, and any shunt-associated complications.

Results: Codman-Hakim-Valves were implanted most frequently (51 pts., 63.7%), followed by Pro-GAV (15 pts., 18.8%) and Delta (14 pts., 17.5%). The initially most frequently used valve opening pressure was 120mmH₂O (45 pts., 56.3%), an adjustment of the valve opening pressure at discharge had to be taken in 6 pts. (7.5%). According to the MRC-NPS, a neurological improvement was registered in 65.0%, no improvement was found in 31.1% and permanent neurological deterioration was registered in 2.5%. During the follow-up, 32.5% of all patients required revision due to malpositioning of the catheters (15.0%), mechanical dysfunction (10.0%) and infection (7.5%).The overall mortality was 0%. The revision rate was highest in implanted Delta-Valves (50.0%), followed by Codman-Hakim (31.4%) and Pro-GAV (20.0%). Infection rates didn´t differ between the different valve types.

Conclusion: This study reflects a typical cohort of patients with normal pressure hydrocephalus and presents neurological outcome and complications of the surgical procedure.