TY - JOUR
T1 - Timing of surgical treatment for idiopathic normal pressure hydrocephalus
T2 - Association between treatment delay and reduced short-term benefit
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
N1 - Publisher Copyright:
© AANS, 2016.
PY - 2016
Y1 - 2016
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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U2 - 10.3171/2016.6.FOCUS16146
DO - 10.3171/2016.6.FOCUS16146
M3 - Article
C2 - 27581314
AN - SCOPUS:84984890247
SN - 1092-0684
VL - 41
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 3
M1 - E2
ER -