Analysis Of Influencing Factors On The Effect Of Ventriculoperitoneal Shunt Surgery In Patients With Idiopathic Normal Hydrocephalus

Background Idiopathic normal pressure hydrocephalus（iNPH）is a disease with no clear cause of ventricular enlargement,manifested as cognitive impairment,gait disturbance and urinary incontinence,and cerebrospinal fluid pressure is within the normal range（70-200mm H₂O）。It is also a neurological disease currently considered to be reversible by surgery.The purpose of this study is to evaluate the surgical efficacy of short-term follow-up of iNPH patients undergoing intraventricular peritoneal shunt surgery,and to explore the influencing factors of iNPH patients’intraventricular peritoneal shunt surgical effect.It is the surgical decision of iNPH,the prediction of the surgical effect and the prognosis for reference.Methods In this study,a retrospective study was used to collect data of clinically suspicious iNPH patients（n=82）from May 2017 to October 2019 in the outpatient and inpatient hospitals of Tianjin Huanhu Hospital.According to the results of the cerebrospinal fluid discharge test,patients with negative test and patients without surgical treatment were excluded.Finally,34 patients undergoing intraventricular shunt surgery were included.The m RS score was used to evaluate the prognosis of the patients 3 months after the operation of ventriculo-peritoneal shunt.According to the difference between the preoperative and postoperative m RS scores,the patients were divided into two groups:the improvement group met the 3 months postoperative m RS score improvement of 1 point or more（n=26）,and the m RS score of the improvement group did not improve or the score becomes worse（n=8）.Compare the differences in general clinical data and imaging data between the two groups.All data are calculated using SPSS 25.0 statistical analysis.Results（1）The overall m RS score of the patient decreased from 2.8±0.7 points before operation to 1.7±1.1 points after operation,the difference was statistically significant（p=0.000）.76.5%of patients had improved m RS scores 3 months after surgery.（2）Compared with the patients in the non-improvement group,the patients in the surgical improvement group had a short course of cognitive impairment,a short course of urinary incontinence,a high MMSE score,a high Mo CA score,a short360-degree turnaround time,and a low ICIQ-IF score.Academic significance（p<0.05）.Other characteristics:age,gender,total disease duration,gait disturbance duration,10m walking time and steps,360-degree turn steps,5m-TUG time,preoperative m RS score,iNPHGS score,Evan’s index,when comparing between groups,No obvious statistical significance was found（p>0.05）.（3）The surgical improvement rate of patients with triad of gait disorder,cognitive impairment and urinary incontinence is 53.3%,which is significantly lower than that of pure gait disorder group（100%）,gait disorder combined with urinary incontinence group（100%）And the gait disorder combined with cognitive impairment group（90%）,but the difference between the groups was not statistically significant（p=0.061）.（4）Surgery improvement rate of patients with severe cognitive impairment is 25%,which is significantly lower than that of mild cognitive impairment group（75%）and moderate cognitive impairment group（76.5%）,but there is no significant statistical difference between the groups（p=0.182）.Conclusion（1）On the basis of a positive cerebrospinal fluid drainage test,iNPH patients have a higher rate of surgical improvement in short-term follow-up after ventriculo-peritoneal shunt surgery.（2）On the basis of a positive cerebrospinal fluid discharge test,the course of cognitive impairment is short,the course of urinary incontinence is short,the MMSE score is high,the Mo CA score is high,and the360-degree turnaround time is short benefit more.For suspected iNPH patients with cognitive impairment and urinary incontinence as the main manifestations,early diagnosis is recommended to shorten the course of cognitive impairment and urinary incontinence,and early ventricular shunt surgery.（3）For patients with typical triad manifestations,the degree of improvement in surgery may be lower than that in patients with simple gait disorder or gait disorder combined with urinary incontinence.For moderate patients,for such patients,shunt surgery needs to be carefully evaluated.This study has certain limitations.We still need further research to supplement the shortcomings of this study,and provide a reference for iNPH surgical decision-making,surgical effect prediction and patient prognosis.