Journal of neuroradiology = Journal de neuroradiologie · 2025
Predicting ventricular volume reduction and overdrainage in idiopathic normal pressure hydrocephalus after ventriculoperitoneal shunt implantation: a radiological study.
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Yeh Pei-Yu, Ho Ue-Cheung, Lu Hsueh-Yi, Huang Shih-Hao, Chen Chi-Ling, Chen Chien-Chia, Kuo Lu-Ting
Аннотация
BACKGROUND AND PURPOSE: Radiological evaluation plays a crucial role in assessing the outcomes of ventriculoperitoneal shunt (VPS) surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). Ventricular volume reduction and overdrainage remain critical concerns after shunt implantation. This study aimed to investigate the radiological changes following VPS surgery and identify predictors of ventricular volume change and overdrainage.
METHODS AND METHODS: This retrospective study included 75 patients with iNPH who underwent VPS implantation using Medtronic Strata NSC adjustable pressure shunts (initial pressure setting: 1.5). Preoperative and postoperative (3-8 weeks) brain imaging was analyzed to measure ventricular volume changes. Patients were stratified into an overdrainage group (with postoperative subdural effusion) and a non-overdrainage group. Univariate and multivariate analyses were performed to identify factors associated with ventricular volume changes and overdrainage risk.
RESULTS: The median preoperative ventricular volume was 100.84 cm³ (IQR: 78.3-130.5 cm³), and the median postoperative volume was 77.57 cm³ (IQR: 55.4-113.4). The median absolute ventricular volume decrease was 19.62 cm³, corresponding to a median percentage reduction of 21.74% (IQR: 4.64-34.87%). Subdural effusion occurred in 18 patients (24.0%), but no subdural hematomas were observed. Multivariate analysis identified older age (p = 0.004) and history of hypertension (p = 0.039) as significant predictors of ventricular volume reduction. Additionally, a greater percentage decrease in ventricular volume (p = 0.005) and absence of hypertension (p = 0.017) were independent risk factors for postoperative subdural effusion.
CONCLUSIONS: Ventricular volume reduction following VPS surgery in iNPH is significantly associated with patient age and hypertension history. Overdrainage risk correlates with greater ventricular volume reduction and the absence of hypertension. These findings provide valuable radiological insights for optimizing shunt pressure settings and minimizing complications in iNPH patients undergoing VPS surgery.
METHODS AND METHODS: This retrospective study included 75 patients with iNPH who underwent VPS implantation using Medtronic Strata NSC adjustable pressure shunts (initial pressure setting: 1.5). Preoperative and postoperative (3-8 weeks) brain imaging was analyzed to measure ventricular volume changes. Patients were stratified into an overdrainage group (with postoperative subdural effusion) and a non-overdrainage group. Univariate and multivariate analyses were performed to identify factors associated with ventricular volume changes and overdrainage risk.
RESULTS: The median preoperative ventricular volume was 100.84 cm³ (IQR: 78.3-130.5 cm³), and the median postoperative volume was 77.57 cm³ (IQR: 55.4-113.4). The median absolute ventricular volume decrease was 19.62 cm³, corresponding to a median percentage reduction of 21.74% (IQR: 4.64-34.87%). Subdural effusion occurred in 18 patients (24.0%), but no subdural hematomas were observed. Multivariate analysis identified older age (p = 0.004) and history of hypertension (p = 0.039) as significant predictors of ventricular volume reduction. Additionally, a greater percentage decrease in ventricular volume (p = 0.005) and absence of hypertension (p = 0.017) were independent risk factors for postoperative subdural effusion.
CONCLUSIONS: Ventricular volume reduction following VPS surgery in iNPH is significantly associated with patient age and hypertension history. Overdrainage risk correlates with greater ventricular volume reduction and the absence of hypertension. These findings provide valuable radiological insights for optimizing shunt pressure settings and minimizing complications in iNPH patients undergoing VPS surgery.