Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus
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Early surgical series of shunt insertion for idiopathic normal-pressure hydrocephalus reported a low rate of short-term improvement with a relatively high rate of mortality and morbidity; subsequently shunt insertion was recommended for patients in whom there is favourable risk-to-benefit ratio.
Bibliographic search for studies that objectively assessed the outcome following shunt insertion in idiopathic normal-pressure hydrocephalus was done; the aim was to estimate the outcome of shunt insertion in terms of improvement rates and associated mortality and morbidity.
A total of 64 studies of 3,063 patients were reviewed. Positive improvement following shunt insertion was reported in an average of 71 % of patients with an average 1 % mortality. Results from studies published in the last 5 years showed 82 % improvement following shunt insertion, mortality of 0.2 %, and combined common complications rate of 8.2 %.
When patients are properly selected, shunt insertion is a safe and effective management of idiopathic normal-pressure hydrocephalus with a prolonged positive outcome.
KeywordsCerebrospinal fluid Curable dementia Idiopathic normal-pressure hydrocephalus Outcome Shunt
The clinical research fellow post at Victor Horsley department of Neurosurgery is supported by a grant from B Braun Medical Ltd. We are grateful to the staff of Rockefeller Medical Library of the UCL Institute of Neurology & National Hospital for Neurology and Neurosurgery for their help in providing the review articles.
Conflicts of interest
The position of clinical research fellow at the adult hydrocephalus service is supported by a grant from B. Braun Medical, Ltd.
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