gms | German Medical Science

Objective: Shunt surgery with programmable valves and anti-siphon devices is known to improve the clinical outcome of a majority of patients with iNPH within a one year-period of time. The aim of this study was to analyze the long term-outcome of iNPH patients after surgery in order to determine how many years of nursing dependency can be saved for the patients by modern shunt surgery.

Methods: The departments shunt database was screened for patients who underwent surgery for iNPH and had complete follow up data after 3, 6 and 9 years. The outcome was measured by the Kiefer score and compared by the NPH recovery rate.

Results: Between 1997 and 2006, 300 patients underwent ventriculoperitoneal shunt surgery due to iNPH. At the reference date, 74 patients had died for several reasons. Two hundred fifty two patients had at least a complete 3-year follow up, 143 patients had a follow up time of 6 years and 77 patients had follow up data 9 years after surgery. The mean age of our patients was 64 years (33-83) years at the time of surgery and 78 years (47-95 years) at the time of follow up. The mean Kiefer score 9 years after surgery was significantly lower indicating a clinical improvement (3.8 vs. 7.5 points, p=0.049) 58 (23%) of the patients after 3 years showed an excellent clinical outcome measured with the NPH recovery rate. 16% showed good clinical results, 36% had a satisfactory and 25% a poor clinical outcome. 6 years after surgery, 47% of the 143 patients had an excellent and 24% a poor outcome. At the 9-year-follow up, 38% of the 77 patients showed an excellent improvement, 27% had good and 19% satisfactory results. 16% of the patients did not benefit.

Conclusion: We achieved a responder rate of 84% on VP shunt surgery with programmable valves after a follow up period of 9 years. Modern shunt surgery seems to be able to save several years of nursing dependence for a majority of the patients.