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The following is a summary of “Long-term outcomes of ventriculoperitoneal shunt therapy in idiopathic normal pressure hydrocephalus,” published in the April 2025 issue of BMC Surgery by Chen et al. 

The long-term functional prognosis of patients with idiopathic normal pressure hydrocephalus (iNPH) after ventriculoperitoneal shunt (VPS) placement remains insufficiently characterized. This study aimed to retrospectively assess the sustained functional outcomes of patients with iNPH treated with VPS and to identify key factors associated with postoperative improvement.

A retrospective analysis was conducted on patients with iNPH who underwent VPS placement. Functional outcomes were systematically evaluated using the modified Rankin Scale (mRS), the iNPH grading scale (iNPHGS), and the Mini-Mental State Examination (MMSE) at baseline (preoperatively) and at follow-up intervals of 1, 2, and 3 years postoperatively. Multivariate regression analysis was employed to determine factors independently associated with changes in these functional scores over time.

VPS placement was associated with significant improvements in both mRS and iNPHGS scores at all postoperative follow-up points (1, 2, and 3 years) compared to preoperative baseline measurements. MMSE scores showed significant gains at the 1-year and 3-year evaluations.

Multivariate regression identified several factors influencing postoperative functional outcomes. At 1 year, changes in mRS scores were significantly associated with the occurrence of postoperative complications and patient education level. By 2 years, postoperative complications remained the primary determinant of mRS improvement. At the 3-year mark, sex, education level, postoperative complications, and smoking status were significantly associated with changes in mRS scores.

Regarding iNPHGS outcomes, sex, age at surgery, and smoking status emerged as significant factors at both 1- and 2-year follow-ups. Changes in MMSE scores were influenced by sex and the duration of preoperative symptoms at 1 year, while postoperative complications, education level, and smoking status were identified as key determinants at 3 years.

This study supports the efficacy and safety of VPS in improving functional outcomes for patients with iNPH over a three-year period. Education level, smoking status, postoperative complications, and the duration of preoperative symptoms were consistently linked to long-term patient outcomes. These findings underscore the importance of addressing modifiable factors such as smoking and optimizing perioperative care to enhance long-term recovery. Further prospective studies are warranted to validate these associations and refine patient selection and postoperative management strategies.

Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02895-9