The benefit of delayed reassessment post high-volume CSF removal in the diagnosis of shunt-responsive idiopathic normal-pressure hydrocephalus. (January 2020)

• Record Type: Journal Article
• Authors: Tsimiklis, Chrisovalantis; Mascarenhas, Annika; To, Minh-Son; Fairley Bishop, Christine; Jenkinson, Felicity; Hunt, Gemma; Knight, Natalie; Harding, Marguerite; Poonnoose, Santosh
• Is Part Of: Journal of clinical neuroscience. Volume 71(2020)
• Page Start: 32
• Page End: 38
• Publication Date: 2020-01
• Subjects: Normal-pressure hydrocephalus -- Idiopathic -- Diagnosis -- Ventriculoperitoneal shunt; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.11.011
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Continued improvements were seen for all mobility and cognitive tests out to 48 h post high-volume CSF removal. 30% of patients proceeded to insertion of a ventriculoperitoneal shunt on the basis of delayed reassessment. This cohort of patients demonstrated benefit from shunt insertion based on outcome measure questionnaires. Delayed reassessment post CSF removal is important in order to capture all possible shunt responders. Abstract: The principle aim of the study was to demonstrate the value of performing delayed reassessment in the diagnosis of idiopathic normal-pressure hydrocephalus (iNPH) and selection of suitable candidates for ventriculoperitoneal shunting (VPS). Thirty-one consecutive patients underwent the NPH protocol at the Flinders Medical Centre between March 2017 and November 2018. The protocol involved mobility and cognitive testing with reassessment post high-volume cerebrospinal fluid (CSF) removal at 24 h and 48 h. The Assessment of Quality of Life 6D (AQoL-6D) questionnaire and International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) were completed and repeated again at 6 weeks and 6 months post shunting. Results were analysed to determine the significance of delayed reassessment. Twenty patients (64.5%) underwent insertion of a VPS on the basis of objective improvements and specific criteria. Of these, 6 patients (30%) were shunted based on delayed reassessment at 48 h post CSF removal. Continued improvements were seen for all mobility and cognitive tests from baseline to 48 h post CSF removal. At 6 weeks and 6 months post shunting, there was an overall mean improvement in AQoL-6D and ICIQ-UI SF for the cohort and the improvement was also observed in the subgroup of patients who met shunt criteria at 48 h post CSF removal. In the diagnosis of shunt-responsive idiopathic normal-pressure hydrocephalus, delayed reassessment post CSF removal improves sensitivity and is therefore important.