Introduction: Previous studies have suggested that a longer duration of preoperative symptoms may correlate with worse post-operative outcomes following VP shunting. The aim of this study was to determine whether duration of symptoms prior to shunting was associated with worse post-operative improvement.
Methods: A retrospective review of 523 patients with communicating hydrocephalus treated with VP shunts by the senior author between 1993 and 2013 was conducted. Duration of symptoms prior to operation was recorded. The following outcome variables were assessed at baseline, 6 months post-op, and at last follow-up: clinical assessment of gait, urinary continence, and cognition; Mini-Mental Status Exam (MMSE); Modified Rankin scale; Barthel ADL index, Wikkelso scores, Timed Up-and-Go test (TUG), Tinetti balance assessment, and Evans index.
Results: Median preoperative duration of symptoms was 25 months and the median follow-up duration was 31 months. Patients that had less than 3 years of preoperative symptoms did not have significantly different baseline Tinetti scores to patients that had greater than 3 years of preoperative symptoms (p = 0.6729). Tinetti scores at last follow-up were significantly better than Tinetti scores at baseline (p = 0.0001). There was no significant difference between the Evans index at baseline and last follow-up (p = 0.7062). Patients that had a longer duration of preoperative symptoms had less reduction in their Evans index at last follow-up (rho = 0.2385, p = 0.0355), but had greater improvement in gait at last follow-up (rho = 0.1807, p = 0.0374). There was not statistically significant correlation between duration of preoperative symptoms and change from baseline in urinary continence, cognition, MMSE, Rankin, Barthel, Wikkelso, or TUG.
Conclusions: Patients with long-standing preoperative symptoms can still receive similar benefit to patients with a shorter duration of preoperative symptoms. These results do not apply to the reported irreversible deterioration occurring with delayed treatment after diagnosis.
Patient Care: This research will improve patient care because it demonstrates that even patients with longstanding symptomatology prior to shunting can still experience significant benefit from having a shunt. This may prevent neurosurgeons from not offering treatment to patients that have had longstanding symptoms.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify an effective treatment for communicating hydrocephalus 2) Describe various measures used to assess patient function prior to and following treatment and 3) Understand the results of the present study in the context of existing research on hydrocephalus management