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Shunting of the over 80s in normal pressure hydrocephalus

  • Original Article - Brain Injury
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Idiopathic normal pressure hydrocephalus is predominantly a disease of the elderly. By its nature, many of those who present to clinic are in advanced old age with multiple comorbidities. Majority of patients treated are younger than 80 years old. We present the clinical outcomes and complication rates of patients over the age of 80 years at the time of operation, during the past 11 years at a single institution.

Methods

Retrospective analysis of clinical records of all patients over the age of 80 years, who presented to our institution between 2006 and 2016. Results were analysed for co-morbidities, immediate and delayed complications, change in mobility/cognitive function post shunting of hydrocephalus.

Results

39 patients (24 male, 15 female) met criteria. Mean [SD] age at the time of shunt insertion was 84 years (+/− 3.22) (range 80–94). No patients developed immediate CSF infection or sub-dural collection, or extended length of stay due to surgical or anaesthetic complications. There were no peri-operative or anaesthetic complications. 4 patients required a delayed surgical revision to encourage greater CSF drainage. 3 patients went on to develop delayed subdural haematoma, 1 of which was associated with trauma, 2 through overdrainage. 1 patient experienced poor post-operative wound healing and subsequently underwent removal of shunt. Of the 34 patient followed up, 27 patients (79.4%) improved in their mobility. (64.7%) patients/families reported symptomatic improvement in their cognition and memory. 6 (17.7%) patients did not experience an improvement in either mobility or cognitive function.

Conclusions

Our data supports the assertion that, with proper patient selection, shunting of the over 80s with iNPH is a safe and effective procedure.

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Abbreviations

iNPH:

idiopathic Normal Pressure Hydrocephalus

CSF:

Cerebrospinal Fluid

VP:

Ventriculoperitoneal

LOS:

Length of Stay

CT:

Computerised Tomography

COPD:

Chronic Obstructive Pulmonary Disease

AF:

Atrial Fibrillation

HF:

Heart Failure

MI:

Myocardial Infarct

TIA:

Transient Ischaemic Attack

SDH:

Sub-dural Haematoma

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Author information

Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Simon D. Thompson, J. D. Shand Smith, A. A. Khan, A. K. Toma & L. D. Watkins

  2. Department of Neuroanaesthesia and Neurocritical Care, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    A. M. V. Luoma

Authors
  1. Simon D. Thompson
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  2. J. D. Shand Smith
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  3. A. A. Khan
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Corresponding author

Correspondence to Simon D. Thompson.

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Funding

No funding was received for this research.

Conflict of interest

Dr. James Shand Smith was funded through a grant from BBraun.

No other conflicts declared.

Ethical approval

For this type of study formal consent is not required.

Additional information

Comments:

Even if retrospectively designed and with a small number of enrolled patients, the study presents a very significant massage for the neurosurgical community: Age alone should be no a block to the treatment of iNPH. In fact, with proper patient selection and careful planning of peri-operative care, shunting of patients over 80 years old with iNPH represents a safe and effective procedure. The paper is clear and well structured.

Our daily clinical experience is similar to the reported data.

Our older patients present analogous operative morbidity and mortality to younger patients too. The outcome is so good, that the QoL rises significantly. The neurosurgical community should be aware of these results.

Alex Alfieri, A. Patrona,

Brandenburg, Germany

Previously presented, in part, at the Society of British Neurological Surgeons Conference, April 2012 and The 7th meeting of the International Society for Hydrocephalus and CSF Disorders conference, September 2014

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Thompson, S.D., Shand Smith, J.D., Khan, A.A. et al. Shunting of the over 80s in normal pressure hydrocephalus. Acta Neurochir 159, 987–994 (2017). https://doi.org/10.1007/s00701-017-3171-7

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  • DOI: https://doi.org/10.1007/s00701-017-3171-7

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