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. 2021 Nov 15;34(3):323-328.
doi: 10.4103/tcmj.tcmj_125_21. eCollection 2022 Jul-Sep.

Lumbar-peritoneal shunt for idiopathic normal pressure hydrocephalus and secondary normal pressure hydrocephalus

Chia-Lin Liao  1 , Pao-Hui Tseng  1   2 , Hsin-Yi Huang  3 , Tsung-Lang Chiu  1   4 , Shinn-Zong Lin  1   4 , Sheng-Tzung Tsai  1   2   4
Affiliations

Lumbar-peritoneal shunt for idiopathic normal pressure hydrocephalus and secondary normal pressure hydrocephalus

Chia-Lin Liao et al. Tzu Chi Med J. .

Abstract

Objectives: Normal-pressure hydrocephalus is a clinical syndrome consisting of dilated cerebral ventricles with the clinical triad of gait disturbance, cognitive impairment and/or urinary dysfunction. Lumbar-peritoneal (LP) shunt could improve idiopathic normal pressure hydrocephalus (iNPH) while its effectiveness on secondary NPH (sNPH) is elusive. We compared the clinical results of the patients who received LP shunt surgery between iNPH and sNPH.

Materials and methods: We retrospectively analyzed the patients who received LP shunt surgery in a single center from January 1, 2017, to June 30, 2017. Patients selected for LP shunt placement had at least two of three cardinal symptoms of iNPH. The symptoms should persist for more than 3 months with compatible brain magnetic resonance imaging findings. All patients were followed up with iNPH grading scale (iNPHGS) and Modified Rankin Scale (MRS) for evaluation.

Results: Thirty-three patients (23 male and 10 female patients) with mean age 76-year-old completed follow-up in this study, and 17 patients received lumbar drainage tests and intracranial pressure measurements. Both iNPH (n = 22) and sNPH (n = 11) groups did not have major complications such as infection, nerve root injury, or shunt failure. Both groups have significant improvement in iNPHGS and MRS. Interestingly, we found the correlation between both opening intracranial pressure and pressure gradient difference to the improvement percentage from LP shunt.

Conclusion: The safety and effectiveness for sNPH patients who received LP shunt placement are equivalent to the iNPH patients. Lumbar drainage test provides prerequisite outcome prediction and should be considered to identify NPH patients planned to receive LP shunt.

Keywords: Lumbar-peritoneal shunt; Normal pressure hydrocephalus; Outcome.

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Conflict of interest statement

Dr. Shinn-Zong Lin, an editorial board member at Tzu Chi Medical Journal, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Flow chart demonstration of the evaluation and treatment protocol for both idiopathic normal pressure hydrocephalus and secondary normal pressure hydrocephalus patients
Figure 2
Figure 2
The results of linear regression analysis between different pressure measurement and clinical improvement after shunt surgery. (a and c): Correlation between opening pressure and neurological improvement (iNPHGS: Idiopathic NPH grading scales); (b and d): Correlation between intracranial pressure difference and neurological improvement
Figure 3
Figure 3
The brain magnetic resonance imaging before the shunt surgery revealed ventriculomegaly. (a and c) The ratio of FH/ID was 0.316 in case one and 0.346 in case two. The FH/ID (FH: Largest width of frontal horns; ID: Internal diameter from inner table of skull to inner table at this level) ratio decreased after surgery, 0.301 in case one and 0.305 in case two respectively. (b and d) Both of the two cases got obvious decreased ventricle size, and postoperative magnetic resonance imaging also revealed remission of periventricular lucency
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