Hydrocephalus in radiation leukoencephalopathy: results of ventriculoperitoneal shunting.

Abstract

OBJECTIVE:

To assess the clinical benefit of ventriculoperitoneal shunting in patients suffering from radiotherapy-induced leukoencephalopathy.

DESIGN:

Retrospective review of a single institutional experience.

PATIENTS:

Thirty-one patients with the postradiotherapy syndrome received ventriculoperitoneal shunts. All had a history of cranial irradiation, progressive ventriculomegaly visible on neuroimaging scans, and neurologic decline; other causes of hydrocephalus were excluded. All 31 patients had cognitive deficits: 30 had gait disturbance and 24 were incontinent.

RESULTS:

Twenty-four (80%) of 30 assessable patients achieved symptomatic improvement an average of 1.6 months after ventriculoperitoneal shunting. Incontinence and gait problems were more likely to improve than cognition. Sixteen (53%) of 30 patients achieved a good overall functional outcome, and incontinence was the only feature significantly associated with good outcome (P=.04). Neither cerebrospinal fluid-opening pressure nor tap tests predicted improvement from ventriculoperitoneal shunting. Median duration of improvement was 6 months, and median survival after receiving the shunt was 14.5 months. Shunt-related complications occurred in 10 (33%) of 30 patients, with 1 fatal outcome.

CONCLUSIONS:

Our results from ventriculoperitoneal shunting in selected patients with radiation-induced hydrocephalus suggest potential benefit. Improvement is incomplete and temporary, but can improve quality of life. Reliable predictors of successful shunt outcome were not identified.

• Authors: B Thiessen, L M DeAngelis
• Journal: Archives of neurology (Arch Neurol) Vol. 55 Issue 5 Pg. 705-10 (May 1998) ISSN: 0003-9942 [Print] United States
• PMID: 9605728 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cognition Disorders (etiology)
• Female
• Gait
• Humans
• Hydrocephalus (etiology, therapy)
• Leukoencephalopathy, Progressive Multifocal (etiology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prognosis
• Radiotherapy (adverse effects)
• Retrospective Studies
• Treatment Outcome
• Ventriculoperitoneal Shunt (adverse effects)