Alberto Feletti1, Domenico d'Avella2, Carsten Wikkelsø3, Petra Klinge4, Per Hellström3, Jos Tans5, Michael Kiefer6, Ulrich Meier7, Johannes Lemcke7, Vincenzo Paternò8, Lennart Stieglitz8, Martin Sames9, Karel Saur9, Mariann Kordás10, Dusan Vitanovic10, Andreu Gabarrós11, Feixa Llarga12, Michael Triffaux13, Alain Tyberghien13, Marianne Juhler14, Stehen Hasselbalch14, Kristina Cesarini15, Katarina Laurell15. 1. Department of Neurosciences, Unit of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy. 2. Department of Neurosciences, Academic Neurosurgery, University of Padova, Padova, Italy. 3. Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island. 5. Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands. 6. Department of Neurosurgery, Saarland University, Homburg-Saar, Germany. 7. Department of Neurosurgery. Akademisches Lehrkrankenhaus der Freien Universität Berlin. Krankenhaus Berlin-Marzahn, Berlin, Germany. 8. Department of Neurosurgery, International Neuroscience Institute Hannover, Hannover, Germany. 9. Department of Neurosurgery, Masaryk Hospital, Usti nad Labem, The Czech Republic. 10. National Institute of Neurosurgery, Budapest, Hungary. 11. Hospital Universitari de Bellvitge, Neurosurgery Department. 12. L'Hospitalet de Llobregat, Barcelona, Spain. 13. Service de Neurochirurgie. Clinique au Jardin Botanique 32, Brussels, Belgium. 14. Neurokirurgisk Klinik NK 2092, Memory Disorders Research Unit, The Neuroscience Center, N6702, Rigshospitalet, Copenhagen, Denmark. 15. Neurologiska kliniken, Akademiska Sjukhuset, Uppsala, Sweden.
Abstract
BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking. OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study. METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed. RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries. CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.
BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking. OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study. METHODS:Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed. RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries. CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.