Timing of surgical treatment for idiopathic normal pressure hydrocephalus: Association between treatment delay and reduced short-term benefit

Sharif Vakili, Dane Moran, Alice Hung, Benjamin D. Elder, Lee Jeon, Hugo Fialho, Eric W. Sankey, Ignacio Jusué-Torres, C. Rory Goodwin, Jennifer Lu, Jamie Robison, Daniele Rigamonti

Research output: Contribution to journalArticle

Abstract

Objective A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. Methods The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: Gait performance, urinary continence, and cognition. Results The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60-70 years, and lack of cognitive improvement in patients aged 70-80 years. Conc lusions Patients with iNPH with longer duration of preoperative symptoms may not receive the same shortterm benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.

Original languageEnglish (US)
Article numberE2
JournalNeurosurgical Focus
Volume41
Issue number3
DOIs
StatePublished - 2016

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Normal Pressure Hydrocephalus
Therapeutics
Gait
Cerebrospinal Fluid
Neurobehavioral Manifestations
Urinary Incontinence
Cognition

Keywords

  • Cognitive decline
  • Gait abnormality
  • Idiopathic normal pressure hydrocephalus
  • Incontinence
  • VP shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Timing of surgical treatment for idiopathic normal pressure hydrocephalus : Association between treatment delay and reduced short-term benefit. / Vakili, Sharif; Moran, Dane; Hung, Alice; Elder, Benjamin D.; Jeon, Lee; Fialho, Hugo; Sankey, Eric W.; Jusué-Torres, Ignacio; Rory Goodwin, C.; Lu, Jennifer; Robison, Jamie; Rigamonti, Daniele.

In: Neurosurgical Focus, Vol. 41, No. 3, E2, 2016.

Research output: Contribution to journalArticle

Vakili, S, Moran, D, Hung, A, Elder, BD, Jeon, L, Fialho, H, Sankey, EW, Jusué-Torres, I, Rory Goodwin, C, Lu, J, Robison, J & Rigamonti, D 2016, 'Timing of surgical treatment for idiopathic normal pressure hydrocephalus: Association between treatment delay and reduced short-term benefit', Neurosurgical Focus, vol. 41, no. 3, E2. https://doi.org/10.3171/2016.6.FOCUS16146
Vakili, Sharif ; Moran, Dane ; Hung, Alice ; Elder, Benjamin D. ; Jeon, Lee ; Fialho, Hugo ; Sankey, Eric W. ; Jusué-Torres, Ignacio ; Rory Goodwin, C. ; Lu, Jennifer ; Robison, Jamie ; Rigamonti, Daniele. / Timing of surgical treatment for idiopathic normal pressure hydrocephalus : Association between treatment delay and reduced short-term benefit. In: Neurosurgical Focus. 2016 ; Vol. 41, No. 3.
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abstract = "Objective A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. Methods The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: Gait performance, urinary continence, and cognition. Results The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60-70 years, and lack of cognitive improvement in patients aged 70-80 years. Conc lusions Patients with iNPH with longer duration of preoperative symptoms may not receive the same shortterm benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.",
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AU - Vakili, Sharif

AU - Moran, Dane

AU - Hung, Alice

AU - Elder, Benjamin D.

AU - Jeon, Lee

AU - Fialho, Hugo

AU - Sankey, Eric W.

AU - Jusué-Torres, Ignacio

AU - Rory Goodwin, C.

AU - Lu, Jennifer

AU - Robison, Jamie

AU - Rigamonti, Daniele

PY - 2016

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N2 - Objective A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. Methods The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: Gait performance, urinary continence, and cognition. Results The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60-70 years, and lack of cognitive improvement in patients aged 70-80 years. Conc lusions Patients with iNPH with longer duration of preoperative symptoms may not receive the same shortterm benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.

AB - Objective A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. Methods The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: Gait performance, urinary continence, and cognition. Results The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60-70 years, and lack of cognitive improvement in patients aged 70-80 years. Conc lusions Patients with iNPH with longer duration of preoperative symptoms may not receive the same shortterm benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.

KW - Cognitive decline

KW - Gait abnormality

KW - Idiopathic normal pressure hydrocephalus

KW - Incontinence

KW - VP shunt

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