• Mahmoud Messerer, Marius Blanchard, Kyriakos Papadimitriou, Alberto Vandenbulcke, Dionys Rutz, Valerie Beaud, Ehab Shiban, Julien Bally, Gilles Allali, Roy T Daniel, and Giulia Cossu.
• Service of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
• World Neurosurg. 2022 Oct 1; 166: e741e749e741-e749.

BackgroundCerebrospinal fluid tap test is a common procedure to predict the efficacy of ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus. Objective tests after cerebrospinal fluid tap test are used to establish the surgical indication, but subjective improvements may also be important in selection of surgical candidates. The aim of this study was to evaluate surgical outcomes of patients with ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus, comparing patients showing objective improvement with patients improving only on subjective assessments.MethodsIn this retrospective analysis, patients were divided into 2 groups: group 1 included patients with improvement on objective evaluation after cerebrospinal fluid tap test; group 2 included patients who showed only subjective improvement. The surgical outcomes of the 2 groups were compared.ResultsOf 28 included patients, 17 were objective responders (group 1), and 11 were subjective responders (group 2). Clinical and radiological characteristics were similar. The only significant difference was the baseline Berg Balance Scale, which was lower in objective responders (P = 0.0015). At 3 months after surgery and at last follow-up, there was no difference in surgical outcomes between the 2 groups. However, in the group of subjective responders, a continuous improvement for incontinence and gait was more frequently observed (P = 0.04 and P < 0.001, respectively).ConclusionsSurgical outcomes after ventriculoperitoneal shunt were similar between the 2 groups, with a more favorable trend in terms of symptom improvement for subjective responders. Subjective assessment seems to be an important factor to consider in preoperative evaluation.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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