World neurosurgery · 2026
Impact of Valve Selection on Clinical Outcomes in Idiopathic Normal Pressure Hydrocephalus: A Retrospective Cohort Study.
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Preložnik Jure, Majer Tilen, Rowbottom Hojka, Ravnik Janez, Šmigoc Tomaž
Аннотация
INTRODUCTION: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder characterized by Hakim's triad: cognitive decline, gait disturbance, and urinary urgency or incontinence, accompanied by ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. Ventriculoperitoneal shunting (VPS) is the standard treatment, with outcomes varying depending on the type of valve utilized. In this study, we compared the impact of programmable versus fixed-pressure valves on treatment outcomes.
METHODS: A retrospective analysis was conducted on patients with iNPH treated at the University Medical Centre Maribor between January 2010 and December 2024. Statistical analysis was performed using Fisher's exact test; odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated.
RESULTS: A total of 73 patients were analysed, with no significant differences in baseline demographics between the valve groups. Although the programmable valve cohort exhibited a higher baseline prevalence of urinary incontinence (77% vs. 54%), this likely reflected a longer preoperative symptom duration. Regarding complications, overdrainage occurred exclusively in the fixed-pressure group (n = 2), while the programmable group showed higher descriptive rates of system malfunction and surgical revision (60% vs. 40%); however, these differences did not reach statistical significance. Revisions in the programmable group also occurred earlier. Overall, clinical improvement was achieved in 90% (n = 66) of the total population. Patients treated with programmable valves demonstrated a significantly higher rate of clinical improvement compared to the fixed-pressure group (98% vs. 77%; OR = 13.8, 95% CI [1.6-122], p = 0.007).
CONCLUSIONS: Our results suggest that patients treated with programmable valves have better clinical outcomes than their counterparts treated with fixed-pressure valves. However, the wide confidence interval reflects limited statistical precision, thus, highlighting the need for larger prospective studies to confirm these findings.
METHODS: A retrospective analysis was conducted on patients with iNPH treated at the University Medical Centre Maribor between January 2010 and December 2024. Statistical analysis was performed using Fisher's exact test; odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated.
RESULTS: A total of 73 patients were analysed, with no significant differences in baseline demographics between the valve groups. Although the programmable valve cohort exhibited a higher baseline prevalence of urinary incontinence (77% vs. 54%), this likely reflected a longer preoperative symptom duration. Regarding complications, overdrainage occurred exclusively in the fixed-pressure group (n = 2), while the programmable group showed higher descriptive rates of system malfunction and surgical revision (60% vs. 40%); however, these differences did not reach statistical significance. Revisions in the programmable group also occurred earlier. Overall, clinical improvement was achieved in 90% (n = 66) of the total population. Patients treated with programmable valves demonstrated a significantly higher rate of clinical improvement compared to the fixed-pressure group (98% vs. 77%; OR = 13.8, 95% CI [1.6-122], p = 0.007).
CONCLUSIONS: Our results suggest that patients treated with programmable valves have better clinical outcomes than their counterparts treated with fixed-pressure valves. However, the wide confidence interval reflects limited statistical precision, thus, highlighting the need for larger prospective studies to confirm these findings.