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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Secondary deterioration in idiopathic normal pressure hydrocephalus in the very long term – treatable or not? A retrospective analysis

Sekundäre Verschlechterung bei iNPH – behandelbar oder nicht?

Meeting Abstract

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  • presenting/speaker Stefanie Kaestner - Klinikum Kassel, Neurochirurgie, Kassel, Deutschland; University of Southampton, Kassel School of Medicine, Kassel, Deutschland
  • Rhea Behrends - Klinikum Kassel, Neurochirurgie, Kassel, Deutschland; University of Southampton, Kassel School of Medicine, Kassel, Deutschland
  • Wolfgang Deinsberger - Klinikum Kassel, Neurochirurgie, Kassel, Deutschland; University of Southampton, Kassel School of Medicine, Kassel, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV110

doi: 10.3205/20dgnc112, urn:nbn:de:0183-20dgnc1126

Veröffentlicht: 26. Juni 2020

© 2020 Kaestner et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Cerebrospinal fluid (CSF) shunting is a highly effective treatment in iNPH, but secondary deterioration can occur in the later course. The aim of this study was to evaluate the rate and causes of secondary deterioration.

Methods: A retrospective analysis of all patients with iNPH treated with CSF-shunt implantation since 1993 was performed. All patients with a secondary deterioration were offered a meticulous "shunt work up". Data related to the number and causes of deteriorations, the subsequent treatment, and the clinical outcome was extracted.

Results: A total of 169 patients with a mean follow-up of 69.2 months could be included. 119 patients (70.4%) experienced a total of 153 secondary deteriorations. In 9 cases delayed subdural haematoma caused the deterioration. In 27 events the cause for deterioration was a proven shunt dysfunction (22.1%). Invasive shunt testing was frequently necessary to confirm shunt failure. The majority of patients (19/27) experienced a good improvement after revision surgery. 86 deteriorations were due to non-surgical causes and the valve pressure was lowered in 79 patients, with only 16.5% showing good amelioration of symptoms.

Conclusion: The majority of shunted iNPH patients deteriorate in the long term. Shunt dysfunction is a valid cause of secondary deterioration. Since shunt revision surgery is highly effective, we recommend that patients with deterioration are screened for shunt dysfunction including invasive shunt testing.