Health-Related Quality of Life and Role of Surgical Treatment in Idiopathic Normal Pressure Hydrocephalus: A Systematic Review

Fabio Torregrossa; Felice Buscemi; Vincenzo Gulino; Benedetta Maria Campisi; Gaia Teresi; Giovanni Grasso

doi:10.1016/j.wneu.2023.08.105

Health-Related Quality of Life and Role of Surgical Treatment in Idiopathic Normal Pressure Hydrocephalus: A Systematic Review

World Neurosurg. 2023 Nov:179:197-203.e1. doi: 10.1016/j.wneu.2023.08.105. Epub 2023 Aug 30.

Authors

Fabio Torregrossa¹, Felice Buscemi¹, Vincenzo Gulino¹, Benedetta Maria Campisi¹, Gaia Teresi², Giovanni Grasso³

Affiliations

¹ Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
² Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
³ Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy. Electronic address: ggrasso@unipa.it.

PMID: 37657591
DOI: 10.1016/j.wneu.2023.08.105

Abstract

Objective: Although shunting has been shown to ameliorate symptoms in idiopathic normal pressure hydrocephalus (iNPH), its impact on health-related quality of life (HRQoL) has yet to be fully elucidated. Patient and caregiver subjective life satisfaction and HRQoL represent crucial indicators for assessing the well-being of individuals facing chronic illnesses, including iNPH. This study aimed to systematically analyze the existing data about HRQoL in iNPH-treated patients to evaluate the role of surgical treatment in such a scenario.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the literature in the PubMed/Medline, Web of Science, and Scopus databases was searched. Fourteen studies met our inclusion criteria. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias.

Results: Overall, HRQoL improved significantly within 1 year after shunt placement although patients with iNPH reported worse HRQoL values compared with healthy-matched individuals. Up to 5 years after shunting, a sustained heterogeneity exists on published data showing improved scores across all domains for at least 21 months after shunting. Further, although surgical treatment can improve HRQoL, long-term follow-up showed that it remained lower than that of healthy controls. These data suggest a significant decrease of HRQoL in patients with iNPH over time after shunting, probably due to aging, comorbidities, and disease progression.

Conclusions: Despite that iNPH has been recognized as a potentially reversible neurological disorder, the available data about the impact of shunting on the HRQoL are unsatisfactory. To improve the well-informed clinical decision-making, it is essential to reach additional high-quality evidence regarding the effect of shunting on HRQoL. New prospective studies, using validated instruments specifically tailored for assessing HRQoL in patients with iNPH, and improved reporting standards are needed. Current evidence suggests that although shunting can provide initial benefits, affected patients may experience long-term impairment in HRQoL.

Keywords: Idiopathic normal pressure hydrocephalus; Outcome; Quality of life; Shunting; Ventriculoperitoneal shunt.

Publication types

Systematic Review
Review

MeSH terms

Cerebrospinal Fluid Shunts
Humans
Hydrocephalus, Normal Pressure* / diagnosis
Prospective Studies
Quality of Life
Treatment Outcome
Ventriculoperitoneal Shunt / adverse effects