Patients with a Normal Pressure Hydrocephalus Shunt Have Fewer Complications than Do Patients with Other Shunts.

Abstract

BACKGROUND:

Ventriculoperitoneal (VP) shunting is a well-established therapy for hydrocephalus. However, complications are frequent. The incidence of idiopathic normal pressure hydrocephalus (NPH) increases with the aging of the population. We evaluated the functional status of patients and the classification of complications associated with VP shunt procedures in our center.

METHODS:

We recorded all VP shunt procedures in our prospective patient registry from January 2013 to December 2015. Functional outcome (Karnofsky Performance Status [KPS] and modified Rankin Scale) and complications were compiled from patient records. Any deviation from the normal postoperative course within 3 months after surgery was considered a complication. Complications were classified with the therapy-oriented Clavien-Dindo grading system. We evaluated potential risk factors with a logistic regression model.

RESULTS:

From 285 procedures in the reporting period, 90 were excluded, resulting in 195 patients. Among those patients, 174 (90%) were shunt implantations and 21 (11%) were shunt revisions. Forty-four shunts (23%) were implanted for NPH. Median KPS improved over the first year after surgery. Although some type of complication was observed in 114 patients (58%), 60 of those complications (31%) did not require surgical treatment (Clavien-Dindo grade <3). In 50 patients (26%), the complication concerned the shunt itself. A high KPS at admission and NPH as underlying indication significantly reduced the odds ratio for a complication.

CONCLUSIONS:

Although shunt surgery has a high general rate of complications, this rate is significantly lower for patients with NPH. The decision for shunting in patients with NPH should consider the low complication rate specific for the group of patients with NPH.

• Authors: Pascale Schenker, Lennart H Stieglitz, Beate Sick, Martin N Stienen, Luca Regli, Johannes Sarnthein
• Journal: World neurosurgery (World Neurosurg) Vol. 110 Pg. e249-e257 (Feb 2018) ISSN: 1878-8769 [Electronic] United States
• PMID: 29109063 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Equipment Failure
• Female
• Humans
• Hydrocephalus, Normal Pressure (surgery)
• Incidence
• Karnofsky Performance Status
• Logistic Models
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Prospective Studies
• Registries
• Retrospective Studies
• Risk Factors
• Treatment Outcome
• Ventriculoperitoneal Shunt
• Young Adult