Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.
Department of Radiation Sciences, Biomedical Engineering, R&D, Umeå University, 901 85, Umeå, Sweden.
J Neurol. 2018 Jan;265(1):178-186. doi: 10.1007/s00415-017-8680-z. Epub 2017 Nov 29.
There is little knowledge about the factors influencing the long-term outcome after surgery for idiopathic normal pressure hydrocephalus (iNPH).
To evaluate the effects of reoperation due to complications and of vascular comorbidity (hypertension, diabetes, stroke and heart disease) on the outcome in iNPH patients, 2-6 years after shunt surgery.
We included 979 patients from the Swedish Hydrocephalus Quality Registry (SHQR), operated on for iNPH during 2004-2011. The patients were followed yearly by mailed questionnaires, including a self-assessed modified Rankin Scale (smRS) and a subjective comparison between their present and their preoperative health condition. The replies were grouped according to the length of follow-up after surgery. Data on clinical evaluations, vascular comorbidity, and reoperations were extracted from the SHQR.
On the smRS, 40% (38-41) of the patients were improved 2-6 years after surgery and around 60% reported their general health condition to be better than preoperatively. Reoperation did not influence the outcome after 2-6 years. The presence of vascular comorbidity had no negative impact on the outcome after 2-6 years, assessed as improvement on the smRS or subjective improvement of the health condition, except after 6 years when patients with hypertension and a history of stroke showed a less favorable development on the smRS.
This registry-based study shows no negative impact of complications and only minor effects of vascular comorbidity on the long-term outcome in iNPH.
关于影响特发性正常压力脑积水（iNPH）患者手术后长期预后的因素知之甚少。
评估因并发症和血管合并症（高血压、糖尿病、中风和心脏病）而再次手术对 iNPH 患者在分流手术后 2-6 年的预后的影响。
我们纳入了瑞典脑积水质量登记处（SHQR）的 979 名患者，这些患者在 2004-2011 年期间因 iNPH 接受了手术。患者每年通过邮寄问卷进行随访，包括自我评估改良 Rankin 量表（smRS）和当前与术前健康状况的主观比较。回复根据手术后的随访时间进行分组。从 SHQR 中提取了临床评估、血管合并症和再次手术的数据。
在 smRS 上，40%（38-41）的患者在手术后 2-6 年内得到改善，约 60%的患者报告他们的整体健康状况比术前更好。再次手术对 2-6 年后的结果没有影响。血管合并症的存在对 2-6 年后的结果没有负面影响，根据 smRS 评估为改善或健康状况的主观改善，但在 6 年后，高血压和中风病史的患者在 smRS 上的预后较差。
这项基于登记的研究表明，并发症不会对 iNPH 的长期预后产生负面影响，只有血管合并症的轻微影响。
