Per Kristian Eide1, Wilhelm Sorteberg2. 1. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: peide@ous-hf.no. 2. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Abstract
OBJECTIVES: To examine the outcome of surgery for idiopathic normal-pressure hydrocephalus (iNPH) and how outcome relates to the preoperative static and pulsatile intracranial pressure (ICP). METHODS: An observational cohort study included all patients with iNPH managed at our department during the years 2002-2012 in whom overnight ICP monitoring was part of the preoperative work-up. Clinical data were retrieved from a quality registry and ICP scores from a pressure database. RESULTS: The study included 472 patients, 316 in the surgery group and 156 in the nonsurgery group. Among those treated surgically, 278 (90%) showed clinical improvement (Responders) whereas 32 (10%) had no improvement (Nonresponders). Among Responders, only about one third reached the best clinical scores; moreover, the difference in clinical score between Responders and Nonresponders declined with time after surgery, particularly after 3-4 years. The surgery was accompanied by acute intracranial hematomas in 11 patients (3.5%), of whom 4 (1.3%) died. Survival (age at death) was significantly greater among the Responders than in Nonresponders. Although the static ICP was normal in all patients, the pulsatile ICP was significantly greater in Responders than in Non-responders. CONCLUSIONS: The pulsatile ICP was greater in shunt Responders than Nonresponders. Although the clinical improvement declined over time and the majority did not experience complete relief of symptoms, shunt Responders lived significantly longer than Nonresponders. The present observations suggest that the current surgical treatment regimens for iNPH (primarily shunt surgery) address only some aspects of the disease process, in particular the aspect of brain water disturbance.
OBJECTIVES: To examine the outcome of surgery for idiopathic normal-pressure hydrocephalus (iNPH) and how outcome relates to the preoperative static and pulsatile intracranial pressure (ICP). METHODS: An observational cohort study included all patients with iNPH managed at our department during the years 2002-2012 in whom overnight ICP monitoring was part of the preoperative work-up. Clinical data were retrieved from a quality registry and ICP scores from a pressure database. RESULTS: The study included 472 patients, 316 in the surgery group and 156 in the nonsurgery group. Among those treated surgically, 278 (90%) showed clinical improvement (Responders) whereas 32 (10%) had no improvement (Nonresponders). Among Responders, only about one third reached the best clinical scores; moreover, the difference in clinical score between Responders and Nonresponders declined with time after surgery, particularly after 3-4 years. The surgery was accompanied by acute intracranial hematomas in 11 patients (3.5%), of whom 4 (1.3%) died. Survival (age at death) was significantly greater among the Responders than in Nonresponders. Although the static ICP was normal in all patients, the pulsatile ICP was significantly greater in Responders than in Non-responders. CONCLUSIONS: The pulsatile ICP was greater in shunt Responders than Nonresponders. Although the clinical improvement declined over time and the majority did not experience complete relief of symptoms, shunt Responders lived significantly longer than Nonresponders. The present observations suggest that the current surgical treatment regimens for iNPH (primarily shunt surgery) address only some aspects of the disease process, in particular the aspect of brain water disturbance.
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Authors: Benjamin C Reeves; Jason K Karimy; Adam J Kundishora; Humberto Mestre; H Mert Cerci; Charles Matouk; Seth L Alper; Iben Lundgaard; Maiken Nedergaard; Kristopher T Kahle Journal: Trends Mol Med Date: 2020-01-18 Impact factor: 11.951
Authors: Geir Ringstad; Lars M Valnes; Anders M Dale; Are H Pripp; Svein-Are S Vatnehol; Kyrre E Emblem; Kent-Andre Mardal; Per K Eide Journal: JCI Insight Date: 2018-07-12
Authors: Per Kristian Eide; Aslan Lashkarivand; Åsmund Aleksander Hagen-Kersten; Øivind Gjertsen; Bård Nedregaard; Ruth Sletteberg; Grethe Løvland; Svein Are Sirirud Vatnehol; Are Hugo Pripp; Lars Magnus Valnes; Geir Ringstad Journal: Front Neurol Date: 2022-04-06 Impact factor: 4.086
Authors: Per K Eide; Espen Mariussen; Hilde Uggerud; Are H Pripp; Aslan Lashkarivand; Bjørnar Hassel; Hege Christensen; Markus Herberg Hovd; Geir Ringstad Journal: JCI Insight Date: 2021-05-10