Two-Years Comparative Clinical Outcome in the Shunt Treatment of Disproportionately Enlarged Subarachnoid Space Hydrocephalus (DESH) and Non-DESH Idiopathic Normal Pressure Hydrocephalus
Keywords:
idiopathic normal pressure hydrocephalus (iNPH), disproportionately enlargement of subarachnoid space with hydrocephalus (DESH), idiopathic normal pressure hydrocephalus grading scale (iNPHGS), modified Rankin scale (mRS), bulbar symptoms, psychiatric symptomsAbstract
Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is known to be a treatable cause of disability and morbidity in elderly patients such as gait abnormality, cognitive decline, and urinary impairment. There are two types of iNPH, disproportionately enlargement subarachnoid space hydrocephalus (DESH) and non-DESH. This study aimed to compare, two-years outcome of treatment in both DESH and non-DESH.
Methods: We conducted a retrospective cohort study of iNPH patients who received surgical treatment between September 2014 and November 2016. Demographic data and baseline clinical were collected. The patient was classified into DESH and non-DESH iNPH groups. Outcomes after treatment such as idiopathic normal pressure hydrocephalus grading scale (iNPHGS), modified Rankin scale (mRS), bulbar symptoms, psychiatric symptoms, and adverse outcomes were analyzed during immediate post-operation, first visit, 4-6 months, 1 year, and 2 years after surgery. The positive outcome was defined as improvement in iNPHGS or mRS at such time.
Results: Patients with iNPH (n =106) were classified as DESH iNPH (n=72) and non-DESH (n = 34). There was a favorable improvement in both groups during the first visit (73.5% in non-DESH and 88.9% in DESH, p = 0.044), 4-6 months (72.7% in non-DESH and 79.4% in DESH group, p = 0.452), 1 year (65.9% in non-DESH group and 79.7% in DESH, p = 0.141) and 2 years (66.7% in non-DESH and 59.6% in DESH group, p = 0.54). There was no difference in outcome according to the type of surgery either ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt at any time.
Conclusion: All patients with a diagnosis of iNPH should receive surgical treatment with or without DESH findings on radiographic imaging. There was a favorable positive outcome with minor shunt-related complications until at least 2 years after surgery. There were no differences between any shunting surgery at any time (either VP or LP shunt).
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