Intracranial Pressure Parameters in Idiopathic Normal Pressure Hydrocephalus Patients Treated with Ventriculo-peritoneal Shunts

Background: Although the mean intracranial pressure (ICP) is normal in patients with idiopathic normal pressure hydrocephalus (iNPH), there could possibly be alterations in their single ICP waves.

Method: Thirty-nine consecutive patients treated for iNPH with ventriculo-peritoneal shunts were followed prospectively with regard to clinical and radiological findings. Changes in clinical state 12 months after shunt surgery were assessed as change on a 15-3 score NPH Grading Scale, while the changes in ventricular size were assessed by linear measures. The ICP recordings were performed as part of routine pre-operative assessment, stored as raw data files, and analyzed retrospectively. The mean ICP as well as single ICP wave amplitudes were computed and analysed in consecutive 6 second time windows.

Findings: Twelve months after shunt surgery, changes in NPH score of 5 or more (very significant improvement) were observed in 12 patients (31%), of 3 to 4 (significant improvement) in 6 patients (15%), of 1 to 2 (slight improvement) in 9 patients (23%) and of -4 to 0 (non-responders) in 12 patients (31%). The ventricular size did not change in any of the outcome categories. While the pre-operative mean ICP was similar between outcome groups, the mean ICP wave amplitude was significantly higher in patients improving clinically as compared to the non-responders.

Conclusions: While pre-operative mean ICP was similar, the mean ICP wave amplitudes were significantly higher in iNPH patients improving clinically after shunt treatment as compared to the non-responders.