ArticleFluids and barriers of the CNS2020
Secondary deterioration in patients with normal pressure hydrocephalus after ventriculoperitoneal shunt placement: a proposed algorithm of treatment.
Article in Fluids and barriers of the CNS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Ventricular volumetry in relation to clinical response and overdrainage after shunt surgery in idiopathic normal-pressure hydrocephalus: a three-year prospective study.Fluids and barriers of the CNS · 2026Article
- PUMP study: reservoir pumping in suspected underdrained shunted patients with normal pressure hydrocephalus - a prospective single-center study.Acta neurochirurgica · 2025Article
- Predictors of shunt response in iNPH: differentiating responders, early and late non-responders, and the role of valve adjustments.Acta neurochirurgica · 2025Article
- Time Course of Symptoms in Normal-Pressure Hydrocephalus: A Systematic Review.Diagnostics (Basel, Switzerland) · 2025Review
- Evaluation of disproportionately enlarged subarachnoid-space hydrocephalus in progressive supranuclear palsy.Brain communications · 2025Article
- Survival After Shunt Therapy in Normal-Pressure Hydrocephalus: A Meta-Analysis of 1614 Patients.Neurology international · 2024Review
- The effectiveness of various CSF diversion surgeries in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis.EClinicalMedicine · 2024Article
- Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus.Frontiers in neurology · 2023Article
- High Periventricular T1 Relaxation Times Predict Gait Improvement After Spinal Tap in Patients with Idiopathic Normal Pressure Hydrocephalus.Clinical neuroradiology · 2022Article
- In vitro testing of explanted shunt valves in hydrocephalic patients with suspected valve malfunction.Neurosurgical review · 2022Article
- Weight and Abdominal Pressure-Induced Shunt Trouble in Patients With Shunted Normal Pressure Hydrocephalus: A Comprehensive Study on Pressure Environment of Shunt System.Frontiers in neurology · 2022Article
- Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model.Journal of clinical medicine · 2021Review
- Using smartphone-based accelerometers to gauge postoperative outcomes in patients with NPH: Implications for ambulatory monitoring.Surgical neurology international · 2021Article
- Association of Preoperative Cerebrospinal Fluids Parameters With Early Shunt Obstruction in Patients With Post-hemorrhagic Hydrocephalus Treated by Lumboperitoneal Shunt.Frontiers in neurology · 2021Article
- Refining the diagnostic evaluation of idiopathic normal pressure hydrocephalus with Alzheimer's and α-synuclein biomarkers.Frontiers in neurologyArticle
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAfter ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) with adjustable gravitational valves, a certain proportion of patients develop secondary clinical worsening after initial improvement of clinical symptoms. The aim of this study was to analyze this group of patients with secondary deterioration and to evaluate the performed shunt management.
methodsFor this investigation, we retrospectively reviewed our NPH registry for patients included between 1999 and 2013 with a decrease by a minimum of two points in the Kiefer score in the first year of follow up and an increase of two points in the Kiefer score between the second and the fifth year after shunt surgery (secondary deterioration). Then, we analyzed the patient's shunt management (adapting the valve pressure setting, shuntography, valve replacement, catheter replacement, implant an adjustable gravitational unit). Additionally, we searched for risk factors for secondary deterioration.
resultsOut of 259 iNPH patients, 53 (20%) patients showed secondary deterioration on an average of 2.7 (2-4 years) years after shunt surgery. Fourteen (26%) patients with secondary deterioration improved after shunt or valve management and 58% remained without clinical benefit after management. We had a drop-out rate of 15% due to incomplete datasets. Our shunt management reduced the rate of secondary deterioration from 20 to 15%. On the basis of our findings, we developed an algorithm for shunt management. Risk factors for secondary deterioration are the age of the patient at the time of shunting, newly diagnosed neurodegenerative diseases, and overdrainage requiring adjusting the valve to higher-pressure levels.
conclusionTwenty percent of patients with iNPH were at risk for secondary clinical worsening about 3 years after shunt surgery. About one-fourth of these patients benefited for additional years from pressure level management and/or shunt valve revision. Our findings underline the need for long-term follow-ups and intensive shunt management to achieve a favorable long-term outcome for patients with iNPH and VPS.
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