Outcomes of hydrocephalus ventriculoperitoneal shunt surgery at a rural hospital

Abstract

Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a disease portrayed by a triad of symptoms, gait disturbance, incontinence, and cognitive impairment. iNPH is common among the elderly population with a 3.7 % prevalence (65 years or older). The main treatment is shunt insertion, to transport cerebrospinal fluid (CSF) from the ventricles to the peritoneal cavity, a ventriculoperitoneal (VP) shunt. Aim To evaluate the shunt response, complication and mortality rate among patients who received a VP-shunt at a rural hospital. Methods Sixty-seven patients underwent surgery at Östersund’s Hospital from 2016 to 2020 after being chosen by a neurologist and a neurosurgeon. In this retrospective study, the medical records of all patients who received a shunt were reviewed, and data were collected using protocols from the Swedish National Hydrocephalus Registry. Patients were tested preoperatively, 3 months and 12 months postoperatively. A modified version of the iNPH score was used to evaluate shunt response. Mortality and cause of death was observed using the death certificate. Complications were found in medical records. Results Three months postoperatively, 82 % of the patients improved significantly in their modified iNPH-score, and 79 % significantly improved in the twelve-months postoperative examination. The six months revision rate was 6 %, caused by infection, subdural hematoma, and distal catheter obstruction. All complications amounted to 9 %, with 3 % being subdural hematoma. Mortality was 15%, with a mean time of 24 months since surgery when the patient died (span: 11-49 months). Conclusion VP shunt surgery for iNPH at a rural hospital resulted in a shunt response rate of 89 %, and a low complication rate (6 %) compared to the literature.