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Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

Journal article
Authors A. Feletti
D. d'Avella
Carsten Wikkelsö
P. Klinge
Per Hellström
J. Tans
M. Kiefer
U. Meier
J. Lemcke
V. Paternò
L. Stieglitz
M. Sames
K. Saur
M. Kordás
D. Vitanovic
A. Gabarrós
F. Llarga
M. Triffaux
A. Tyberghien
M. Juhler
S. Hasselbalch
K. Cesarini
K. Laurell
Published in Operative neurosurgery
Volume 17
Issue 1
Pages 97-102
ISSN 2332-4260
Publication year 2019
Published at Institute of Neuroscience and Physiology
Pages 97-102
Language en
Keywords Complication, Idiopathic normal pressure hydrocephalus, Multicenter study, Symptoms and signs, Ventriculoperitoneal shunt
Subject categories Neurosurgery


BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking. OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study. METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed. RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries. CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo. Copyright © 2018 by the Congress of Neurological Surgeons.

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