J Neurosurg 143:1254–1261, 2025
This clinical study evaluates objective, longitudinal gait changes in 212 patients with idiopathic normal pressure hydrocephalus (iNPH) following ventriculoperitoneal shunt (VPS) placement, using serial instrumented motion analysis over a median 12-month follow-up. Short-term analyses show significant improvements in all measured gait metrics within three months, with gait velocity, stride length, and stability ratio demonstrating the largest gains.
Longitudinal modeling with generalized additive mixed-effects models reveals that improvements in velocity, stride length, and single support emerge early and plateau around six months, while cadence changes are minimal until later follow-up. The authors note persistent but incomplete recovery relative to healthy norms, discuss methodological limitations, and call for multicenter prospective studies linking objective gait metrics to patient-reported outcomes.
• Idiopathic Normal Pressure Hydrocephalus (iNPH) Characteristics: iNPH is marked by progressive gait disturbance, cognitive impairment, and urinary incontinence, with gait abnormalities increasing fall risk and often presenting as shuffling, short stride, and instability.
• Ventriculoperitoneal Shunt (VPS) Treatment: VPS placement is the standard of care for iNPH, aiming to improve symptoms by diverting cerebrospinal fluid (CSF) after confirmation of shunt responsiveness via CSF tap test.
• Objective Gait Assessment: Gait parameters—including velocity, cadence, stride length, step width, stability ratio, and support phases—were measured using a pressure-sensitive walkway before and at multiple intervals after VPS placement.
• Short-Term Gait Improvements: Statistically significant improvements in all gait parameters were observed within 3 months post-VPS, with the greatest changes in gait velocity (+27%), stride length (+17.5%), and gait stability ratio (−14.1%).
• Longitudinal Gait Outcomes: Improvements in gait velocity, stride length, and single support phase continued up to 6 months post-surgery, then plateaued and persisted through 24 months, although not reaching normative values seen in healthy controls.
• Majority of Patients Benefit: Over 80% of patients experienced improvement in most gait parameters, with durable benefits maintained through long-term follow-up.
• Limitations: The study’s retrospective, single-center design and specialized gait analysis setup may limit generalizability; potential biases include loss to follow-up and lack of control for comorbidities.
• Clinical Implication: Objective gait analysis validates durable improvement after VPS in iNPH, supporting its use for monitoring surgical outcomes and informing patient care.
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