Predictors of Shunt Responsiveness and Long-term Outcomes in Idiopathic Normal Pressure Hydrocephalus: A Retrospective Cohort Study
Dror Shir1, Noa Bregman1, Elissa Ash2, Tamara Shiner1
1Neurology, Tel-Aviv Medical Center, 2Tel Aviv Sourasky Medical Center
Objective:
This study aimed to identify clinical, imaging, and CSF biomarkers associated with favorable long-term outcomes following shunt placement.
Background:
Idiopathic Normal Pressure Hydrocephalus (iNPH) remains a challenging clinical diagnosis with variable treatment response.
Design/Methods:
All patients evaluated for iNPH at the Tel-Aviv Medical Center (TLVMC) between 2020 and 2022 were included. Participants underwent clinical, cognitive, and imaging assessments, high-volume lumbar puncture (LP). LP responders were referred for shunt placement, and outcomes assessed at one year.
Results:
183 patients were evaluated; 167 met criteria for suspected iNPH and underwent LP. Sixty-two (37%) patients showed improvement after CSF drainage and were referred for shunting of these, 38 (61%) underwent shunt placement. Gait disturbance was the most common presenting symptom (68%), and more frequent in LP responders (p=0.007), whereas cognitive symptoms were more common among non-responders (29.5% vs. 10%). LP responders had lower CSF total tau (t-tau) (222.6 ± 99.1 vs. 256 ± 107.1, p=0.045) and protein (41.1 ± 17.1 vs. 49.1 ± 25.7, p=0.032), and were more likely to exhibit a disproportionately enlarged subarachnoid-space hydrocephalus (DESH) pattern (73% vs. 46%, p<0.001). Among the 38 shunted patients, 21 (55%) had a favourable outcome at one year which was associated with lower t-tau (p=0.056) and more frequent DESH (p=0.026).
Conclusions:
A significant proportion of patients with suspected iNPH benefit from CSF shunting. Lower t-tau and DESH pattern were associated with better outcomes.
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