Outcome after ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus

• Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement
• Programmable gravitational valves in idiopathic normal pressure hydrocephalus: long-term outcomes after a 3-year follow-up
• Idiopathic normal pressure hydrocephalus: associations between CSF biomarkers, clinical symptoms, and outcome after shunt surgery
• Utilization of a Telemetric Prechamber in the Management of Patients with Normal Pressure Hydrocephalus
• Preoperative imaging biomarkers combined with tap test for predicting shunt surgery outcome in idiopathic normal pressure hydrocephalus: a multicenter retrospective study
• Long-term outcomes after shunt surgery in older patients with idiopathic normal pressure hydrocephalus
• Neuroimaging predictors of favorable outcomes after shunting procedures in patients with Hakim-Adams syndrome: a pilot prospective randomized trial
• Improvement of the vestibular functions as measured by video head Impulse test in patients undergoing ventriculoperitoneal shunt surgery for Idiopathic normal pressure Hydrocephalus: Moving Forward in a yet unexplored territory

• 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

—-

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 ¹⁾.

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 ²⁾.

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 ³⁾.

Outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus (INPH) are variable due to a lack of reliable, quantitative outcome data and inconsistent methods of selecting shunt candidates.