BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking. OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study. METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed. RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries. CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.

Department of Neurology Medical Centre Haaglanden The Hague The Netherlands

Department of Neurosciences Academic Neurosurgery University of Padova Padova Italy

Department of Neurosciences Unit of Neurosurgery NOCSAE Modena Hospital Modena Italy

Department of Neurosurgery Akademisches Lehrkrankenhaus der Freien Universität Berlin Krankenhaus Berlin Marzahn Berlin Germany

Department of Neurosurgery International Neuroscience Institute Hannover Hannover Germany

Department of Neurosurgery Masaryk Hospital Usti nad Labem The Czech Republic

Department of Neurosurgery Saarland University Homburg Saar Germany

Department of Neurosurgery The Warren Alpert Medical School of Brown University Rhode Island Hospital Providence Rhode Island

Hospital Universitari de Bellvitge Neurosurgery Department

Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

L'Hospitalet de Llobregat Barcelona Spain

National Institute of Neurosurgery Budapest Hungary

Neurokirurgisk Klinik NK 2092 Memory Disorders Research Unit The Neuroscience Center N6702 Rigshospitalet Copenhagen Denmark

Neurologiska kliniken Akademiska Sjukhuset Uppsala Sweden

Service de Neurochirurgie Clinique au Jardin Botanique 32 Brussels Belgium

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