Background

Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration.

Methods

A retrospective analysis was conducted on all patients with iNPH who were treated with implantation of a CSF shunt since 1993. A meticulous shunt workup was recommended to all patients who presented to our department with secondary deterioration during their follow-up visits. Data about the proportion of patients with such deterioration and its causes, subsequent treatment, and clinical outcome were obtained.

Results

A total of 169 patients were included, and the mean follow-up time was 69.2 months. In total, 119 (70.4%) patients presented with a total of 153 secondary deteriorations. In 9 cases (5.9%), the deterioration was caused by delayed subdural hematoma and in 27 (22.1%) cases, by shunt dysfunction. Invasive shunt testing was commonly required to validate shunt failure. Moreover, 19 of 27 patients experienced a satisfactory improvement after revision surgery. In total, 86 deteriorations were attributed to nonsurgical causes, and the valve pressure was decreased in 79 patients, with only 16.5% presenting with a satisfactory improvement after lowering of valve pressure.

Conclusions

Most patients with shunted iNPH presented with deterioration in the later course of the disease. Shunt dysfunction was considered a cause of secondary deterioration. Moreover, shunt revision surgery was a highly effective treatment, and patients with deterioration should undergo screening procedures for shunt dysfunction, including invasive shunt testing.

中文翻译：

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特发性正常压力脑积水继发恶化的治疗：回顾性分析。

背景

脑脊液（CSF）分流术是特发性正常压力脑积水（iNPH）的高效治疗方法。但是，随后会发生二次变质。因此，当前的研究旨在评估发生率和继发性恶化的原因。

方法

对自1993年以来接受CSF分流术治疗的所有iNPH患者进行回顾性分析。建议对所有在随访期间就诊为继发性恶化的患者进行细致的分流检查。获得了有关此类恶化患者的比例及其原因，后续治疗和临床结果的数据。

结果

总共包括169名患者，平均随访时间为69.2个月。共有119名患者（70.4％）出现了153次继发性恶化。在9例（5.9％）的病例中，恶化是由迟发性硬膜下血肿引起的，而在27例（22.1％）的病例中，是由分流功能障碍引起的。通常需要侵入式分流器测试来验证分流器故障。此外，27例患者中有19例在翻修手术后获得了令人满意的改善。总共有86例恶化归因于非手术原因，其中79例患者的瓣膜压力降低，只有16.5％的患者在降低瓣膜压力后表现出令人满意的改善。

结论

患有iNPH分流的大多数患者在疾病后期出现恶化。分流功能障碍被认为是继发性恶化的原因。此外，分流翻修术是一种非常有效的治疗方法，病情恶化的患者应接受分流功能障碍的筛查程序，包括侵入性分流测试。