Outcome in Normal Pressure Hydrocephalus after Ventriculoperitoneal Shunt in Tertiary Care Hospital

  • Abdul Samad Panezai Sandeman Civil Hospital, Quetta, Pakistan
  • Aurangzeb Kalhoro Jinnah Medical and Dental College
  • Sher Hassan Jinnah Medical and Dental College, Karachi
  • Farrukh Javeed Jinnah Postgraduate Medical Centre, Karachi,
  • Lal Rehman Jinnah Postgraduate Medical Centre, Karachi,
Keywords: Normal Pressure Hydrocephalus, VP Shunt


Objective:  To determine the outcome of the ventriculoperitoneal shunt in normal pressure hydrocephalus.

Material and Methods:  This study was conducted at Jinnah Postgraduate Medical Centre, a tertiary care hospital in Karachi. Patients with idiopathic normal pressure hydrocephalus (NPH) were included. Gender distribution, presentation of symptoms and post-operative outcome based on the Stein Langfitt Scale were assessed. CSF was sent for microbiological and biochemical analyses. All patients were evaluated preoperatively and compared postoperatively during 6 months duration for improvement and any associated complication.

Results:  In this study, we had 47 patients, 38 were male and 9 were female. 22 patients presented with dementia, 18 with urinary incontinence, 17 with gait disturbance 17, while 21 had headache based on Stein and Langfitt Scale. The 78.8% patients had an excellent outcome, 17% had a good outcome and 4.2% had poor results.

Conclusion:  Ventriculoperitoneal (VP) shunt had promising results selected on history and examination of normal pressure hydrocephalus and improved radiological in Evan’s ratio CT brain scan.

Keywords:  Normal Pressure Hydrocephalus (NPH), VP Shunt, Stein and Langfitt Scale.


1. Daou B, Klinge P, Tjoumakaris S, Rosenwasser RH, Jabbour P. Revisiting secondary normal pressure hydrocephalus: does it exist? A review. Neurosurg Focus, 2016; 41 (3): E6.
2. Espay AJ, Da Prat GA, Dwivedi AK, Rodriguez‐Porcel F, Vaughan JE, Rosso M, Devoto JL, Duker AP, Masellis M, Smith CD, Mandybur GT. Deconstructing normal pressure hydrocephalus: ventriculomegaly as early sign of neurodegeneration. Annals of Neurology, 2017; 82 (4): 503-13.
3. Chen Z, Liu C, Zhang J, Relkin N, Xing Y, Li Y. Cerebrospinal fluid Aβ42, t-tau, and p-tau levels in the differential diagnosis of idiopathic normal-pressure hydrocephalus: a systematic review and meta-analysis. Fluids and Barriers of the CNS. 2017; 14 (1): 13.
4. Nassar BR, Lippa CF. Idiopathic normal pressure hydrocephalus: a review for general practitioners. Gerontology and Geriatric Medicine, 2016 Apr. 19; 2: 2333721416643702.
5. Schirinzi T, Sancesario GM, Di Lazzaro G, D’Elia A, Imbriani P, Scalise S, Pisani A. Cerebrospinal fluid biomarkers profile of idiopathic normal pressure hydrocephalus. Journal of Neural Transmission, 2018; 125 (4): 673-9.
6. Feletti A, d’Avella D, Wikkelsø C, Klinge P, Hellström P, Tans J, Kiefer M, Meier U, Lemcke J, Paternò V, Stieglitz L. Ventriculoperitoneal shunt complications in the European idiopathic normal pressure hydrocephalus multicenter study. Operative Neurosurgery, 2019; 17 (1): 97-102.
7. Miyajima M, Kazui H, Mori E, Ishikawa M. One-year outcome in patients with idiopathic normal-pressure hydrocephalus: comparison of lumboperitoneal shunt to ventriculoperitoneal shunt. Journal of Neurosurgery, 2016; 125 (6): 1483-92.
8. Hung AL, Vivas-Buitrago T, Adam A, Lu J, Robison J, Elder BD, Goodwin CR, Jusué-Torres I, Rigamonti D. Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus. Clinical Neurology and Neurosurgery, 2017; 157: 1-6.
9. Picascia M, Pozzi NG, Todisco M, Minafra B, Sinforiani E, Zangaglia R, Ceravolo R, Pacchetti C. Cognitive disorders in normal pressure hydrocephalus with initial parkinsonism in comparison with de novo Parkinson's disease. European Journal of Neurology, 2019; 26 (1): 74-9.
10. Oliveira LM, Nitrini R, Román GC. Normal-pressure hydrocephalus: A critical review. Dementia & Neuropsychologia, 2019; 13 (2): 133-43.
11. Mathew R, Pavithran S, Byju P. Neuropsychiatric manifestations of cognitively advanced idiopathic normal pressure hydrocephalus. Dementia and Geriatric Cognitive Disorders Extra, 2018; 8 (3): 467-75.
12. Sharma AK, Gaikwad S, Gupta V, Garg A, Mishra NK. Measurement of peak CSF flow velocity at cerebral aqueduct, before and after lumbar CSF drainage, by use of phase-contrast MRI: utility in the management of idiopathic normal pressure hydrocephalus. Clinical Neurology and Neurosurgery, 2008; 110 (4): 363-8.
13. Chang CC, Asada H, Mimura T, Suzuki S. A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus. Journal of Neurosurgery, 2009; 111 (3): 610-7.
14. Isik AT, Kaya D, Bulut EA, Dokuzlar O, Soysal P. The outcomes of serial cerebrospinal fluid removal in elderly patients with idiopathic normal pressure hydrocephalus. Clinical Interventions in Aging, 2019; 14: 2063.
15. Liew BS, Takagi K, Kato Y, Duvuru S, Thanapal S, Mangaleswaran B. Current updates on idiopathic normal pressure hydrocephalus. Asian Journal of Neurosurgery, 2019; 14 (3): 648.
16. Ahmad M, Niaz A, Majeed S, Vohra AH, Bokhari MH. Normal Pressure Hydrocephalus: Selection of patients for shunt placement. Pakistan Journal of Neurological Surgery, 2014; 18 (2): 145-8.
17. Assoumane I, Al-Zekri M, Khelifa A, Touati N, Lagha N, Said AS, Morsli A. Subdural Hematoma Complicating Ventriculoperitoneal Shunts: An Algerian Centers Experience. Indian Journal of Neurosurgery, 2020. Doi:10.1055/s-0039-3402592
18. McGovern RA, Nelp TB, Kelly KM, Chan AK, Mazzoni P, Sheth SA, Honig LS, Teich AF, McKhann GM. Predicting cognitive improvement in normal pressure hydrocephalus patients using preoperative neuropsychological testing and cerebrospinal fluid biomarkers. Neurosurgery, 2019; 85 (4): E662-9.
Original Article