Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience

Oliveira, Matheus Fernandes de; Sorte, A. A. Boa; Emerenciano, Daniel; Rotta, José Marcus; Mendes, G. A. S.; Pinto, Fernando Campos Gomes

doi:10.1007/s13760-020-01538-5

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…This higher mortality can be attributed to life-threatening complications, including late infection, bowel perforation, delayed intracerebral or subdural hemorrhage, and delayed diagnosis of shunt malfunction, which are more frequently observed months to years after VPS placement. Moreover, the benefits of shunting in patients with iNPH decrease over time [25,28].…”

Section: Discussionmentioning

confidence: 99%

Comparing the Long-Term Cardiovascular Outcomes of Lumbo-Peritoneal, Ventriculo-Peritoneal, or Non-Shunting Treatment after Idiopathic Normal Pressure Hydrocephalus: A Nationwide Retrospective Cohort Study

Chiu,

et al. 2024

Int. J. Med. Sci.

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Purpose: With advances in medical technology, the average lifespan has increased, leading to a growing significance of idiopathic normal pressure hydrocephalus (iNPH), particularly in the elderly population. Most patients with iNPH have been treated either with ventriculo-peritoneal shunts (VPS) or conservative measures. However, lumbo-peritoneal shunts (LPS) have emerged as an alternative treatment option for iNPH in recent decades, extensive research still lacks comparing outcomes with LPS to those with VPS or non-surgical treatment. The aim of the resent study is to disclose the long-term therapeutic outcomes of LPS, VPS, and non-shunting in patients with iNPH. Methods: We used the National Health Insurance Research Database in Taiwan to assess the long-term outcomes of these treatment options. We enrolled 5,537 iNPH patients who received shunting surgery, of which 5,254 were VPS and 283 were LPS. To compare the difference between each group, matching was conducted by propensity score matching using a 1:1 ratio based on LPS patients. Primary outcomes included death and major adverse cardiovascular events (MACEs) Results: Our findings show that VPS resulted in significantly more MACEs than non-surgical treatment (Odds ratio: 1.83, 95% confidence interval: 1.16-2.90). In addition, both VPS and LPS groups had significantly lower overall mortality rates than non-shunting group. Moreover, LPS had lower overall mortality but similar MACEs rates to VPS. Ivyspring International PublisherConclusions: Based on these findings, we propose that the LPS is preferable to the VPS, and surgical treatment should be considered the primary choice over conservative treatment unless contraindications are present.

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Section: Discussionmentioning

confidence: 99%

Comparing the Long-Term Cardiovascular Outcomes of Lumbo-Peritoneal, Ventriculo-Peritoneal, or Non-Shunting Treatment after Idiopathic Normal Pressure Hydrocephalus: A Nationwide Retrospective Cohort Study

Chiu,

et al. 2024

Int. J. Med. Sci.

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“… 11 Whilst short term follow-up shows good clinical improvement (83%), this parameter decreases to 38% long term. 12 There is little evidence to show the superiority of a specific type of valve over another. 13 , 14 Anti-siphon/gravity devices are associated with less subdural CSF collections and hematomas 9 Quality of life in patients with NPH is associated with pre-operative cognitive status, overweight and age.…”

Section: Introductionmentioning

confidence: 99%

“… 18 Programmable valves tend for lower complication rate. 19 , 12 Valve dysfunction can be associated with diffuse and obscure clinical manifestation and may appear as malfunction rather than complete obstruction. 20 One study didn't find significant differences in the incidence of hygromas and subdural hematomas between flow-regulated and gravitational valves.…”

Section: Introductionmentioning

confidence: 99%

17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves

Zipfel,

Kohlmann-Dell’Acqua,

Noell

et al. 2024

World Neurosurgery: X

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“…The postoperative management after CSF-shunt implantation requires regular clinical and radiological follow-ups, including reprogramming the valve opening pressure or even surgical revision in case of dysfunction [10]. Factors like infection, dislocation, obstruction or disconnection are often discussed as a reason for the high need for interventions [11,12].…”

Section: Introductionmentioning

confidence: 99%

Valve pressure adjustments of cerebrospinal fluid shunts – longitudinal analysis of 614 patients

Schön

Krigers

Klingenschmid

et al. 2023

Preprint

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Background The implantation of a cerebrospinal fluid (CSF) shunt is one of the most common interventions in neurosurgery. However, there is a high rate of re-interventions e.g., surgical revisions, changes of valve pressure or radiological examinations. Various operating techniques, shunt valves and settings have been used in the past decades. Our goal was to investigate the clinical and technical characteristics influencing the need for intervention. Methods 614 patients between 2000 and 2019 which were treated surgically or seen as out-patients with a CSF-shunt dependent hydrocephalus at our department were longitudinally analyzed. Interventions were defined as any change in valve pressure setting or revision surgery. The clinical and technical data were retrospectively collected and analyzed using integrated regression and cox regression. Results 289 (47.1%) male and 325 (52.9%) female patients with a median age of 61 years (IqR: 47 – 70), with 441 (71.9%) ventriculoperitoneal shunts (VP) and 150 (24.4%) ventriculoatrial shunts, 351 (57.7%) programmable and 257 (42.3%) non-programmable shunts were documented. The median follow-up was 53.9 months (CI95%: 47.5 – 60.2, range: 0 – 463). Female patients were looked after significantly longer (60.0 months, CI95% 50.9 - 69.1). The average time until the first intervention was 98 months (IqR: 81.8 – 115.2). Gender, height, weight and BMI did not influence the need for earlier intervention. In long-term follow-up, valve pressure which never needed an intervention was influenced by the type of the shunt (VA or VP) and the programmability of the valve. Gender, height, weight and BMI had no impact on the pressure setting. Conclusion The individual pressure setting with none to fewer interventions is influenced by the programmability of the CSF-shunt, the age of the patient and the shunt-type. Gender, height, weight and BMI are not clinically relevant to identify the ideal valve pressure.

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Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience

Cited by 6 publications

References 39 publications

Comparing the Long-Term Cardiovascular Outcomes of Lumbo-Peritoneal, Ventriculo-Peritoneal, or Non-Shunting Treatment after Idiopathic Normal Pressure Hydrocephalus: A Nationwide Retrospective Cohort Study

Comparing the Long-Term Cardiovascular Outcomes of Lumbo-Peritoneal, Ventriculo-Peritoneal, or Non-Shunting Treatment after Idiopathic Normal Pressure Hydrocephalus: A Nationwide Retrospective Cohort Study

17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves

Valve pressure adjustments of cerebrospinal fluid shunts – longitudinal analysis of 614 patients

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