Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival

J Neurosurg. 2018 Sep;129(3):797-804. doi: 10.3171/2017.5.JNS17481. Epub 2017 Oct 27.

Abstract

OBJECTIVE Subdural hematoma (SDH) is the most common serious adverse event in patients with shunts. Adjustable shunts are used with increasing frequency and make it possible to noninvasively treat postoperative SDH. The objective of this study was to describe the prevalence and treatment preferences of SDHs, based on fixed or adjustable shunt valves, in a national cohort of patients with shunted idiopathic normal pressure hydrocephalus (iNPH), as well as to evaluate the effect of SDH and treatment on long-term survival. METHODS Patients with iNPH who received a CSF shunt in Sweden from 2004 to 2015 were included in a prospective quality registry (n = 1846) and followed regarding SDH, its treatment, and mortality. The treatment of SDH was categorized into surgery, opening pressure adjustments, or no treatment. RESULTS During the study period, the proportion of adjustable shunts increased from 75% to 95%. Ten percent (n = 184) of the patients developed an SDH. In 103 patients, treatment was solely opening pressure adjustment. Surgical treatment was used in 66 cases (36%), and 15 (8%) received no treatment. In patients with fixed shunt valves, 90% (n = 17) of SDHs were treated surgically compared with 30% (n = 49) in patients with adjustable shunts (p < 0.001). There was no difference in long-term patient survival between the SDH and non-SDH groups or between different treatments. CONCLUSIONS SDH remains a common complication after shunt surgery, but adjustable shunts reduced the need for surgical interventions. SDH and treatment did not significantly affect survival in this patient group, thus the noninvasive treatment offered by adjustable shunts considerably reduces the level of severity for this common adverse event.

Keywords: NPR = National Population Registry; SDH = subdural hematoma; SHDR = Swedish Hospital Discharge Registry; SHQR = Swedish Hydrocephalus Quality Register; cerebrospinal fluid shunt; complications; hydrocephalus; iNPH = idiopathic normal pressure hydrocephalus; normal pressure; subdural hematoma; survival; treatment.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebrospinal Fluid Pressure / physiology
  • Cerebrospinal Fluid Shunts / adverse effects*
  • Cerebrospinal Fluid Shunts / instrumentation
  • Cerebrospinal Fluid Shunts / mortality
  • Cohort Studies
  • Equipment Design
  • Equipment Safety
  • Female
  • Follow-Up Studies
  • Hematoma, Subdural / mortality
  • Hematoma, Subdural / surgery*
  • Humans
  • Hydrocephalus, Normal Pressure / mortality
  • Hydrocephalus, Normal Pressure / physiopathology
  • Hydrocephalus, Normal Pressure / surgery*
  • Male
  • Prospective Studies
  • Registries
  • Survivors
  • Sweden