AUTHOR=Nakajima Madoka , Miyajima Masakazu , Ogino Ikuko , Akiba Chihiro , Kawamura Kaito , Kurosawa Michiko , Kuriyama Nagato , Watanabe Yoshiyuki , Fukushima Wakaba , Mori Etsuro , Kato Takeo , Sugano Hidenori , Karagiozov Kostadin , Arai Hajime 

TITLE=Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus Improves Patient Outcomes: A Nationwide Hospital-Based Survey in Japan

JOURNAL=Frontiers in Neurology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00421

DOI=10.3389/fneur.2018.00421

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> This study aimed to investigate the efficacy of cerebrospinal fluid shunt intervention for idiopathic normal pressure hydrocephalus (iNPH) using data from a nationwide epidemiological survey in Japan.</p><p><bold>Methods:</bold> We conducted a cross-sectional study using data from a nationwide epidemiological survey performed in Japan. Propensity score matching was used to select 874 patients from 1,423 patients aged ≥60 years, who were diagnosed with iNPH based on clinical guidelines following a hospital visit in 2012. Patients who experienced an improvement of at least 1 modified Rankin Scale (mRS) grade after the intervention were classified as “improved,” while the remaining patients were classified as “non-improved.” In the shunt intervention (<italic>n</italic> = 437) and non-shunt intervention (<italic>n</italic> = 437) groups, the differences in mRS grade improvement were analyzed using the Mann-Whitney <italic>U</italic>-test. Finally, we examined subjects in the shunt intervention group (<italic>n</italic> = 974) to compare the outcomes and complications of ventriculoperitoneal (VP) shunt (n = 417) with lumboperitoneal (LP) shunt (<italic>n</italic> = 540).</p><p><bold>Results:</bold> We examined subjects with iNPH to compare the non-shunt intervention group to the shunt intervention group following adjustment for age and mRS grade at baseline by propensity score matching (0.31–0.901). The mRS grade (mean [SD]) was found to improve with non-shunt intervention (2.46 [0.88]) and shunt intervention (1.93 [0.93]) (<italic>p</italic> &lt; 0.001) in iNPH patients. The mRS outcome score and complications comparison between the VP and LP shunt groups did not show significant difference.</p><p><bold>Conclusions:</bold> In this study, analysis of the efficacy of shunts for possible iNPH conducted in Japan indicated a significant improvement in the mRS grade between baseline and outcome within 1 year, regardless of the surgical technique, and shunt intervention was found to be effective.</p>