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Preoperative Predictive Factors of Short-Term Outcome in Idiopathic Normal Pressure Hydrocephalus (iNPH).

World Neurosurgery 2021 April 23
BACKGROUND: Surgical treatment of iNPH by ventriculoperitoneal (VP) or lumboperitoneal (LP) shunting can achieve long-term recovery of activities of daily living (ADLs), however in a subset of patients maintenance of independence lasts for less than six months. This study examined positive preoperative predictive factors of short-term outcome for shunted iNPH patients. METHODS: Over a 9-year period, consecutive patients from multiple centers diagnosed with probable iNPH underwent either VP or LP shunt surgery. Preoperative variables of age, symptom duration, iNPH severity, tap test response, and MRI findings of disproportionately enlarged subarachnoid space hydrocephalus (DESH) or incomplete DESH were retrospectively evaluated in relation to 1-year postoperative outcome.

RESULTS: Outcome for 154 shunt patients (12 VP, 142 LP) as measured by postoperative disability (mRS) and gait disturbance (iNPH-GD) was the same regardless of age. Symptom duration was inversely correlated with both iNPH severity (p<0.0001) and postoperative improvement at 1 year (P=0.0015). Severity also correlated inversely with postoperative improvement at 1 year (P<0.0001). Age was not significantly correlated with the degree of postoperative improvement (mRS: p=0.487; iNPHGS(GD): p=0.725). Outcome at one year (mRS, gait domain (Gd) and ADLs significantly improved in patients with a good response to the tap test (P<0.0001) Preoperative DESH correlated with improvement in mRS and GD (p<0.0001).

CONCLUSIONS: Mild preoperative iNPH severity, shorter preoperative symptom duration, good tap test response, and complete DESH were associated with good short-term postoperative outcome at 1 year. These positive factors may be useful for prediction of short-term surgical outcome in iNPH patients.

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