Journal of Korean Society of Geriatric Neurosurgery 2015;11(2):226-231.
Published online September 30, 2015.
The Efficacy of Surgical Treatment in Elderly Normal-Pressure Hydrocephalus Patients Based on Symptom Triads
Sang-Youp Han , Chul-Ku Jung , Cheol-Young Lee , Hyun-Woo Kim , Jong Hyun Kim
Department of Neurosurgery, Konyang University College of Medicine, Daejon, Korea
Abstract
Objective
Normal-pressure hydrocephalus (NPH) is remarkable that is reversible through shunt surgery, but there exists no level I evidence to support the efficacy of shunt surgery in NPH. For these reasons, the clinical outcome of shunt surgery in elderly NPH patients based on symptom triads was evaluated and reported herein.
Methods
A total of 30 patients were included in this study. Lumbar tap with removal of cerebrospinal fluid (CSF) was performed. Before and after the tap test (TT), all the patients were evaluated using the gait gradinge scale, Mini-Mental State Examination (MMSE), and the urinary incontinence grade scale. Their clinical outcomes were assessed using the modified Rankin scale (mRS). The radiologic outcomes were assessed based on the postoperative computed tomography (CT) image and using the Evans index, to determine the presence of intracranial complications.
Results
Thirty patients (100%) had gait disturbance, 23 patients (76%) had urinary incontinence, and 11 patients (36%) had memory impairment. Eleven patients (36%) responded to the TT, and 19 patients did not. One year after the shunt operation, 25 patients (83%) showed improvement in the gait grading scale. Eleven patients (50%) showed urinary incontinence improvement. Fifteen patients (50%) showed MMSE improvement. Twenty patients (66%) showed mRS improvement. Among these patients, only eight responded to the TT. The median Evans index is changed from 0.34 (range: 0.3-0.44) to 0.31 (range: 0.27-0.36).
Conclusion
Shunt surgery is a safe and effective management modality of elderly normal-pressure hydrocephalus (NPH).
Key Words: Normal-pressure hydrocephalusㆍTap testㆍVentriculoperitoneal shunt


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