Neurosurgery Blog

Neurosurgery 68:416–419, 2011 DOI: 10.1227/NEU.0b013e3181ff9d01

Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect.

OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects.

METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months.

RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P< .003) and Symbol Digit Modalities (P< .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P< .001) and caregivers reported improved activities of daily living (P , .01) and reduced caregiver distress (P< .01).

CONCLUSION: This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.

Neurosurgery 66:523-529, 2010 DOI: 10.1227/01.NEU.0000364996.97762.73

During the past decade, numerous reports have supported the contribution  of awake mapping in surgical removal of brain lesions in eloquent areas, with a significant  increase of the extent of resection while minimizing the risk of permanent deficit—and  even improving quality of life.

METHODS: Most of these awake procedures were performed in patients with lesions in  language areas, to avoid postoperative aphasia. Surprisingly, mapping of nonlanguage  functions received less attention, despite the possible consequences of deficits other than  aphasia on daily life. Visuospatial and cognitive deficits are reported after brain surgery,  because of more objective and extensive neuropsychological assessments.

RESULTS AND CONCLUSION: This review provides new insights into the indications of  awake craniotomies for nonlanguage mapping in surgery for lesions in areas not related  to language processing.