Serious adverse events following Normal Pressure Hydrocephalus surgery

Objective: Recent Normal Pressure Hydrocephalus (NPH) practice guidelines describe a serious adverse event (SAE) rate following surgery of 11%. Patients & methods: We conducted a retrospective review of 162 consecutive patients who have undergone workup at our center's multidisciplinary NPH clinic over a 47 month time period (2/2014-12/2017). Of these, 22 ultimately underwent neurosurgical ventricular shunt surgery as treatment for NPH. Clinical records were reviewed for SAEs categorized as possibly/probably/definitely related to NPH surgery. Results: In 10/22 (45.5%) operated subjects, there were 11 qualifying SAEs over this 3-year period: 1 central nervous system infections, 4 subdural hematomas, 2 seizures resulting in hospitalization, 1 catheter malfunction, 2 perioperative AEs, and 1 death of uncertain cause. Eight SAEs were coded as probably/definitely related. Six occurred > 3 months from the time of surgery. Conclusions: SAEs following NPH surgery are common. Additional studies are needed to determine the long-term safety of NPH surgery in older adults.