AUTHOR=Sun Ran , Ning Haibo , Ren Ning , Xing Xiuying , Chen Xuejiao , Li Guihua , Li Xin , Chen Lei 

TITLE=Evaluation of Surgical Treatment Effect on Idiopathic Normal Pressure Hydrocephalus

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.856357

DOI=10.3389/fsurg.2022.856357

ISSN=2296-875X

ABSTRACT=Background: We aimed to observe the long-term effectiveness and safety of ventriculo-peritoneal (V-P) shunt in treating idiopathic normal-pressure hydrocephalus (iNPH). 
Methods: A total of 65 patients with iNPH were retrospectively analyzed. All patients were treated with V-P shunt, and the clinical efficacy was assessed using follow-up questionnaire, Modified Rankin Scale (mRS) and iNPH grading scale (iNPHGS) after operation.
Results: The mean mRS and iNPHGS scores were (1.18±0.83) points and (2.98±1.96) points, respectively, which were statistically significantly different from those before operation [(2.89±0.92) points and (6.49±2.30) points, respectively]. Besides, the patients were divided into non-improvement group (n=8, 12.3%), improvement group (n=16, 24.6%) and marked improvement group (n=41, 63.1%) based on the preoperative and postoperative mRS scores, and the total effective rate of V-P shunt was 87.7%. Next, 7 patients with negative cerebrospinal fluid tap test (Tap test) received active V-P shunt, and the score on walking disorder was (2.71±0.76) points before operation and (1.86±0.90) points after operation, showing a statistically significant difference. Moreover, 12 (18.4%) patients had complications after operation, among whom 5 (7.7%) manifested ameliorated symptoms after replacing shunt tube and receiving anti-infection treatment, but 3 (4.6%) showed no alleviation following pressure adjustment due to advanced age and multiple complications. 6 (9.2%) cases of death were recorded during follow-up, and only 1 (1.5%) case of sudden death occurred within 2 weeks after operation. In addition, it was found through more than 5 years of follow-up after operation that 12 out of the 23 (52.2%) patients had a good effect at 5 years after operation, 1 (4.3%) patient had been confined to bed due to advanced age and pulmonary infection, and 1 (4.3%) patient died of pulmonary infection and heart failure.
Conclusion: The V-P shunt is effective in treating iNPH, and it results in a preferable long-term prognosis.