Clinical Efficacy Of Ventriculo-peritoneal Shunt In The Treatment Of Idiopathic Normal Pressure Hydrocephalus

Objective To investigate the Clinical efficacy of ventriculo-peritoneal shunt in the treatment of idiopathic normal pressure hydrocephalus.Methods A total of 41 patients of iNPH were diagnosed solely on clinical and radiological findings during the period time from 2012.01 to 2015.02. And VPS with Adjustable vavle undergone to all of them. Re-examinations, 6 months after surgery, were performed in 38 patients. Evaluation were taken before and after operation(6 months)in terms of CT results, 10 m walking test, MoCA, incontinence score, modified Rankin scale(mRs) which were analyzed and compared after operation so as to learn the clinical characteristics of iNPH and the efficacy of VPS.Results Preoperative imaging of the 38 patients showed ventriculomegaly,, EI>0.3; the cerebral ventricles were reduced 6 months after surgery, compared with EI, the difference was statistically significant(P < 0.001). The gait velocity and stride length which were evaluated by 10 m walking test increased 6 months after shunting(P<0.001). The improvement rate in the gait domain was 73.7%. The MoCA results showed that total scores before treatment were between 18 and 25(normal score between 26 and 30). Cognitive impairment presented with impairment in visuospatial and executive functions, attention, and episodic memory before treatment. The total score of MoCA was improved compared with that before operation(P<0.05), 19 cases after treatment scored more than 26 points, which indicated that 50% of the 38 patients who could be evaluated 6 months after surgery were improved on the MoCA. Comparison in each item of MoCA indicated that significant improvement was seen in visuospatial and executive functions and in attention(P < 0.001) except in episodic memory(P > 0.05). There were statistically significant differences in the incontinence score after surgery(P<0.01). 52.2% of the 23 patients who could be evaluated 6 months after surgery were improved were improved by one step. 60.5% of the 38 patients who could be evaluated 6 months after surgery were improved on the mRs overall assessment(P<0.001), 34.2% patients were improved by one step, 21.1% by two steps and 5.3% by three steps. The proportion of patients able to live independently(scores 0-2 on the mRs) was increased from 52.6% before surgery to 73.7% 6 months after.Conclusion VPS can improve the clinical symptoms of most patients with iNPH. Improvement in the gait domain is obvious, which is more than in the domains of continence and neuropsychology, MoCA evaluation shows that the cognitive impairment is partly improved 6 months after surgery especially in visuospatial and executive functions, attention, but improvement in memory function is difficult. patients with iNPH diagnosed solely on clinical and radiological criteria support shunt surgery to improve the quality of life of patients.