Article
Long-term follow up after shunt surgery for normal pressure hydrocephalus – an analysis of symptom progression, Evan’s index and optimal VP-shunt settings
Langzeitverlauf nach Shunt-Implantation bei Normaldruckhydrozephalus – eine Analyse des Symptomverlaufs, des Evan’s Index und der optimalen VP-Shunt-Einstellung
Search Medline for
Authors
-
Aylin H. Gencer
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
-
Frank P. Schwarm
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
-
Jasmin Nagl
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
-
Eberhard Uhl
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
-
Malgorzata A. Kolodziej
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Published: | June 4, 2021 |
|---|
Outline
Text
Objective: Ventriculoperitoneal (VP) shunt implantation is a well-established treatment method for patients with normal pressure hydrocephalus (NPH). This retrospective study aims to investigate the effects of this type of surgery on patients in the long-term and to find an optimal opening pressure of the programmable valve based on gender.
Methods: The data of NPH patients, who underwent VP-shunt implantation between 2004 and 2020, were retrospectively evaluated. Gait disturbance, cognitive impairment, urinary incontinence and Evan’s index values were analyzed preoperatively and 6, 12, 24 and 36 months postoperatively. The initial opening pressure of the programmable valve and every readjustment during the follow-up period was documented along with symptomatic changes at each pressure setting. Paired sample t-test and bivariate Pearson correlation were performed to analyze the data.
Results: The cohort consisted of 132 patients (87 male, 45 female) with a median age of 72.7. Median time of follow-up was 11.3 months. There was a significant reduction of the symptoms immediately after the implantation of the shunt system (p<0.01). However, no significant change was observed at the different time points during the long-term follow-up period up to three years. Similarly, Evan’s index was significantly reduced directly postoperatively (p<0.05), but showed no further improvement after that. No correlation between the reduction of symptoms and the Evan’s index was found. Valve opening pressure showed a significant relation to the gender of patients (p<0.01). The mean optimal opening pressure dependent on gender and overall symptom improvement was calculated to be 119.9±3.6 mmHg for women and 134.3±2.2 mmHg for men.
Conclusion: VP-shunt implantation is effective with regard to clinical and radiological outcomes of NPH patients, although these two factors seem to be independent of each other. In the long-term, patients show decreased rates of improvement when compared to immediate postoperative results. When choosing the opening pressure of the valve the gender of the patient should be taken into consideration.
