AUTHOR=Fang Xuhao , Deng Yao , Xu Xinxin , Shu Weiquan , Tang Feng , Li Shihong , Zhu Ting , Zhang Li , Zhong Ping , Mao Renling 

TITLE=One-year outcome of a lumboperitoneal shunt in older adults with idiopathic normal pressure hydrocephalus

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.977123

DOI=10.3389/fsurg.2022.977123

ISSN=2296-875X

ABSTRACT=Background: LPS is now an effective surgical modality for iNPH, but there is still a lack of clinical data on LPS in older adult iNPH patients in China. We aim to report the shunt effect and the complications of older adult iNPH patients treated with LPS at a single center in Shanghai, China. 
Methods: We conducted a retrospective study among the adults over 60 years old who were diagnosed as iNPH and treated with LPS from September 2016 to December 2020. The shunt effect was evaluated from two dimensions of functional and symptomatic improvement three months and one year after surgery, respectively. The potential factors related to the shunt effect one year after surgery were explored by comparing the effect between different subgroups and conducting multivariate logistic regression analysis.
Result: 85 patients were included in this study, ranging from 60 to 93 years old, with an average age of 74.7. Function and symptoms were better both three months and one year after surgery than before (P<0.001). At the one-year post-operation follow-up, the functional and symptomatic improvement rates were 72.9% and 90.6% respectively. The symptomatic improvement rates of gait, urination and cognition were 74.1%, 72.9% and 60.0% respectively. Multivariate logistic regression analysis showed the improvement of function was much more possible in patients with less than 24 months from symptom onset to surgery (OR=24.57, P<0.001) and those with DESH present (OR=5.88, P=0.048); the improvement in gait was also more possible in patients with less than 24 months from symptom onset to surgery (OR=5.29, P=0.017); the improvement in urination was more possible in patients with diabetes (OR=4.76, P=0.019) and the improvement of cognition was more possible in patients with preoperative mRS level lower than 4 (OR=3.51, P=0.040). Minor operation-related complications were seen in 27 patients (31.8%) and severe complications in 6 patients (7.1%).
Conclusion: LPS could improve the function and symptoms of older adult iNPH patients. Early detection, diagnosis and treatment of the disease could improve the shunt effect of the patients. Older adult iNPH patients with higher age ranges could achieve comparable shunt results compared with the young old.