Outcome after ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus [Neurosurgery Wiki]

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====== Outcome after ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus ======

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===== Outcomes =====
  * Gait improvement: most common and consistent benefit (up to 80%)
  * Cognitive and urinary symptoms: may improve, but less predictably
  * Early intervention correlates with better prognosis
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Patients with idiopathic normal pressure hydrocephalus (iNPH) who undergo ventriculoperitoneal shunt (VPS) placement often belong to an older demographic, putting them at increased risk of postoperative delirium and related complications. Recent literature documenting the use of Enhanced Recovery After Surgery (ERAS) protocols in various disciplines of surgery has shown improved clinical outcomes, faster discharge, and lower readmission rates. Early return to a familiar environment (i.e., discharged home) is a well-known predictor of reduced postoperative delirium. However, ERAS protocols are uncommon in neurosurgery, especially intracranial procedures
((Ali A, Gupta B, Johansen P, Santiago RB, Dabecco R, Mandel M, Adada B, Botero J, Roy M, Borghei-Razavi H. Enhanced recovery after surgery in patients with normal pressure hydrocephalus undergoing ventriculoperitoneal shunting procedures. Clin Neurol Neurosurg. 2023 Jul;230:107757. doi: 10.1016/j.clineuro.2023.107757. Epub 2023 May 5. PMID: 37196458.)).
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VPS implantation, along with a strict and comprehensive follow-up, has been shown to improve QOL in iNPH patients for as long as 5 years after surgery. Younger age, lower BMI, and better MMSE score are positive predictors of improved QOL after shunt placement
((Grasso G, Torregrossa F. The impact of cerebrospinal fluid shunting on quality of life in idiopathic normal pressure hydrocephalus: a long-term analysis. Neurosurg Focus. 2023 Apr;54(4):E7. doi: 10.3171/2023.1.FOCUS22643. PMID: 37004132.)).
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Activity monitoring provides an early objective measure of improvement in gait [[entropy]] after VPS placement among patients with iNPH, although a more significant improvement was noted on the detailed clinical gait assessments. Further long-term studies are needed to determine the utility of remote monitoring for assessing gait improvement following VPS placement
((Jusue-Torres I, Brown DA, Pennington Z, Cogswell PM, Ali F, Graff-Radford N, Jones DT, Cutsforth-Gregory JK, Graff-Radford J, Kaufman KR, Elder BD. Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study. Neurosurg Focus. 2023 Apr;54(4):E6. doi: 10.3171/2023.1.FOCUS22640. PMID: 37004136.)).
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[[Outcome]]s after [[ventriculoperitoneal shunt]]ing for [[idiopathic normal pressure hydrocephalus]] (INPH) are variable due to a lack of reliable, quantitative [[outcome]] data and inconsistent methods of selecting shunt candidates.