• Susanne Nienhaus, Walter Stummer, and Khaleghi GhadiriMaryamMDepartment of Neurosurgery, University of Münster, Münster, Germany. Electronic address: Maryam.KhaleghiGhadiri@ukmuenster.de..
• Department of Pediatric, Christliches Kinderhospital Osnabrück, Osnabrück, Germany.
• World Neurosurg. 2023 Jun 8.

ObjectiveIdiopathic normal pressure hydrocephalus (NPH) is commonly accompanied by diverse comorbidities that impact the postoperative course and result in a distinction between shunt responders and shunt non-responders. This study aimed to enhance diagnostics by identifying prognostic differences between NPH patients, individuals with comorbidities, and those with other complications.MethodsThe data of 119 patients with NPH coding at the University Clinic Münster from January 2009 to June 2017 were examined. The study primarily concentrated on examining symptoms, comorbidities, and radiological measurements, including callosal angle (CA) and Evans index (EI). To evaluate the progression of symptoms, a novel scoring system was developed to quantitatively assess the course at specific time points: 5-7 weeks, 1-1.5 years, and 2.5 years after the operation. This scoring system aimed to provide a standardized approach for measuring and tracking the development of symptoms over time. Logistic regression analyses were employed to identify predictor associated with 3 key outcomes: shunt implantation, surgical success, and the development of complications.ResultsAmong the comorbidities observed, hypertension was the most prevalent. Gait disturbance, in the absence of polyneuropathy, was identified as a predictor of a favorable surgical outcome. Hygroma development was associated with a combination of vascular factors and cognitive disorders. The presence of spinal/skeletal changes, diabetes, and vascular constellations were found to increase the likelihood of developing complications.ConclusionsThe evaluation of comorbidities accompanied by NPH holds significant importance and necessitates meticulous observation, expertise, and multidisciplinary care.Copyright © 2023 Elsevier Inc. All rights reserved.

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