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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Frail patients with idiopathic normal pressure hydrocephalus equally benefit from shunting

Gebrechliche Patienten mit idiopathischem Normaldruckhydrozephalus profitieren gleichermaßen von Shunt-Operationen

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  • presenting/speaker Mohammad Hazaymeh - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Christian von der Brelie - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Silvia Hernández-Durán - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV065

doi: 10.3205/21dgnc066, urn:nbn:de:0183-21dgnc0667

Published: June 4, 2021

© 2021 Hazaymeh et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Multiple studies have shown a strong correlation between frailty and perioperative outcome in different surgical disciplines. In this study, we evaluated frailty in patients with idiopathic normal pressure hydrocephalus (iNPH) and the possible associations it could have with overall perioperative response and outcome.

Methods: We retrospectively evaluated patients older than 65 years of age with iNPH who underwent ventriculoperitoneal shunt (VPS) surgery for the first time between 2010 and 2020. The diagnosis of iNPH was made radiologically as well as clinically with a trial of cerebrospinal fluid (CSF) drainage (either lumbar tap test or lumbar drain) in all cases. We evaluated every patient's frailty with the clinical frailty score (CFS) and dichotomized them in “frail” (CFS>4) and “non-frail” (CFS<5). The severity of iNPH was objectivized with the NPH Score by Sorteberg et al preoperatively, postoperatively, and at last follow-up. Our primary endpoint was the need for valve pressure adjustment due to worsening of NPH symptoms. Secondary endpoint was overall benefit from VPS, as objectivized by an improvement of >2 points in the NPH Score at last follow-up.

Results: One hundred forty-four patients were included in this study. Mean age at surgery was 75 years. In our cohort, 46 (32%) patients were considered frail. Mean NPH Scores pre- and postoperatively were 10 and 12, respectively, showing a statistically significant improvement of NPH symptoms postoperatively in a paired-samples t-test (p<.001). CFS had a statistically significant correlation with the severity of NPH symptoms at presentation (p<.001). Valve readjustment was necessary in 70 (49%) patients, with worsening of NPH symptoms being the cause in 48 of them. Frailty did not predict the need for readjustment (p=.898), and frail and non-frail patients benefited equally from VPS (p=.920). Furthermore, frail individuals were not at an increased risk for overdrainage (p=.632).

Conclusion: Frailty is increasingly used to select elderly patients for surgical treatment or best supportive care. While frailty predicts greater impairment from iNPH symptoms preoperatively, frail iNPH patients also benefit from VPS. Thus, frail individuals should not be dismissed from surgical therapies for iNPH.