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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Secondary non-responding versus shunt insufficiency in patients with idiopathic normal pressure hydrocephalus after shunt surgery

Sekundäre NonResponder versus Shuntinsuffizienz bei Patienten mit idiopathischem Normaldruckhydrozephalus nach V.p.-Shuntimplantation

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  • presenting/speaker Sergej Rot - Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Pawel Gutowski - Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Ullrich Meier - Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Michael Fritsch - Diakonie Klinikum Dietrich Bonhoeffer, Neurochirurgie, Neubrandenburg, Deutschland
  • presenting/speaker Johannes Lemcke - Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP005

doi: 10.3205/19dgnc344, urn:nbn:de:0183-19dgnc3447

Published: May 8, 2019

© 2019 Rot et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Following ventriculo-peritoneal (vp) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) with programmable gravitational valves, a certain proportion of patients develop secondary clinical worsening after initial improvement of the clinical symptoms. The aim of this study is to analyze this group of secondary non-responders.

Methods: Fourhundredthirtysix (436) consecutive patients with iNPH were prospectively included in our shunt registry (mean age 74 years) and underwent surgery with implantation of vp shunts with programmable low pressure valves plus non-programmable gravitational units (pressure level 50-70 mmH2O plus 200-300 mmH2O). All patients were routinely followed up 1, 2, 3, 4, 5, 6 and 7 years after shunt surgery.

Results: After surgery, 375 patients showed clinical improvement measured by the Kiefer score (86% primary responders). Among these patients, we observed secondary worsening of at least two points (Kiefer Score) in 82 patients (18%) after a mean period of 2.7 years folowing shunt surgery. In 62 of these patients, the low pressure valve was re-programmed to pressure levels between 0 and 30 mmH2O. 20 of these patients underwent shunt fluoroscopy with contrast medium (shuntography). 27 Patients underwent a replacement of the non-programmable gravitational unit by a programmable gravitational unit. 20 (24%) of these patients improved after taking action. 54 (65%) patients showed no improved after the procedures. We had a drop out-rate of 8 (11%) patients.

Conclusion: According to our data, about 20% of surgically treated patients with iNPH are at risk for secondary clinical worsening within 3 years after shunt surgery. Approximately one quarter of these patients benefited for additional years from pressure level management and/or shunt valve revision. The findings underline that iNPH is a dynamic disease even after surgery. We conclude that lifelong follow up is needed for these patients.