Langzeit-Nachverfolgung beim Normaldruckhydrocephalus

Normal pressure hydrocephalus (iNPH) is characterized by a slowly progressive clinical triad of gait disorder, cognitive decline and urinary incontinence combined with ventricular dilation. Studies on short-term outcome after ventriculoperitoneal shunt implantation have shown a clinically significant improvement in 80 to 85% of patients after surgery. However, long-term results have rarely been published.

A consecutive series of 165 patients (mean age 74.7 ± 7.4 years) treated by a single surgeon with a ventriculoperitoneal (VP) shunt between 2012 und February 2023 at the neurosurgical department of University Hospital Zurich with mean preoperative DESH score of 6.8 ± 2.7 were included in this retrospective study. They were followed without limit yearly or more frequently in case of need. Preoperative patient selection was based on clinical evaluation, radiological findings, and CSF dynamic supplemental tests. Outcomes were assessed using the Kiefer Scale and the NPH-Recovery Rate (NPH-RR). Secondarily, the number of steps needed for 180° turn as a measure of gait disturbance, the Montreal Cognitive Assessment (MoCA) score as a measure of cognitive decline and continence of patients were recorded preoperatively and at the last follow-up.

The mean preoperative Kiefer Score was 7.3 ± 3.1, significantly higher than the Kiefer Score 6 months, 1, 2, 3, 4, 5 (p < 0.001) and 6 years (p = 0.006) after shunting procedure. The lowest Kiefer Score of 2.9 ± 2.7 was reached one year postoperatively with subsequent continuous slight increase to 4.1 ± 2.6 at the 6-year postoperative follow-up. The NPH-RR in the first 3 years after shunting procedure was greater than 5 and therefore representing a good clinical outcome. The number of steps for 180° turn decreased from 4.4 ± 1.9 preoperatively to 2.8 ± 1.6 postoperatively. 28 of 165 patients (17.0 %) underwent MoCA testing both pre- and postoperatively, with 9 patients (32.1 %) showing significant improvement. The proportion of urinary incontinent patients decreased from 70.4 % to 29.6 %.

Patients with iNPH benefit significantly from shunt therapy up to 6 years postoperatively, with improvements noted among all components of the clinical triad.