Long-term outcomes of adult chronic idiopathic hydrocephalus treated with a ventriculo-peritoneal shunt

Neurologia. 2017 May;32(4):205-212. doi: 10.1016/j.nrl.2015.10.002. Epub 2015 Dec 31.
[Article in English, Spanish]

Abstract

Introduction: Adult chronic idiopathic hydrocephalus (ACIH) is a cause of dementia that can be treated by implanting a ventriculo-peritoneal shunt (VPS). We aim to study clinical and functional outcomes in patients with ACIH corrected with a VPS.

Subjects and methods: Observational cohort study of patients diagnosed with probable ACIH (Japan Neurosurgical Society guidelines) and undergoing shunt placement between 2008 and 2013 in a centre of reference for neurosurgery in Spain. Clinical improvement was classified in 4 categories (resolution, partial improvement, equivocal improvement, and no improvement); functional outcome was assessed on the modified Rankin scale (mRS).

Results: The study included 29 patients with a mean age of 73.9 years; 62.1% were male and 65.5% had hypertension. Clinical improvement (complete or partial) was observed in 58% after one year and in 48% by the end of the follow-up period (mean follow-up time was 37.8 months). Older age, presence of hypertension, and surgery-related complications were more prevalent in the group responding poorly to treatment. One patient died, 20.7% experienced severe complications, and 69% were dependent (mRS ≥ 3) by the end of the follow-up period. Age at diagnosis was independently associated with poorer clinical response at one year and a higher degree of dependency by the end of follow-up.

Conclusion: Symptomatic benefits offered by VPS were partial and transient; treatment was associated with a high complication rate and poor functional outcomes in the long term, especially in the oldest patients.

Keywords: Chronic adult hydrocephalus; Derivación ventrículo-peritoneal; Epidemiology; Epidemiología; Hidrocefalia crónica del adulto; Hidrocefalia normotensiva; Normal pressure hydrocephalus; Tratamiento; Treatment; Ventriculo-peritoneal shunt.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Aged
  • Female
  • Humans
  • Hydrocephalus / complications
  • Hydrocephalus / surgery*
  • Hypertension / etiology
  • Longitudinal Studies
  • Male
  • Prospective Studies
  • Risk Factors
  • Spain
  • Treatment Outcome
  • Ventriculoperitoneal Shunt / methods*