Abdelrahman M Hamouda1, Maria D. Astudillo Potes1, Zachary Pennington1, Rahul Kumar 1, Mahnoor Shafi1, Hana Hallak1, Sandesh Bhat4, Asghar Rezaei4, Ignacio Jusue-Torres1, Jonathan Graff-Radford2, David T Jones2, Hugo Botha2, Jeremy K Cutsforth-Gregory2, Farwa Ali2, Petrice M Cogswell3, Kenton R Kaufman4, Benjamin D Elder1 1Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; 2Department of Neurology, Mayo Clinic, Rochester, MN, USA; 3Department of Radiology, Mayo Clinic, Rochester, MN, USA; 4Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, USA Correspondence: Benjamin D Elder (elder.benjamin@mayo.edu)

Fluids and Barriers of the CNS 2024, 21(Suppl 1):125

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait deterioration, cognitive disturbances, and urinary incontinence. Gait instability can result in frequent falls, yet objective assessments of gait improvement following ventriculoperitoneal shunt (VPS) placement are limited. The present study aims to assess objective improvement in gait parameters following VPS placement for iNPH.

Methods: All patients treated with VPS for iNPH by the senior author at a single tertiary care center between December 2017 and January 2023 were retrospectively reviewed with inclusion of patients who underwent detailed motion analysis testing (gait velocity, gait cadence, stride length, stride width, gait stability ratio, right and left legs total support, single support, initial double, and step length support) preoperatively and at interval follow-up (1-, 6-, 12-, and 24-months) with statistical comparisons performed using paired Wilcoxon rank test.

Results: A total of 157 patients (mean age 75.5 years, 64.3% male) met inclusion criteria. At 24-month follow-up, statistically significant (p < 0.001) improvements from baseline gait metrics were noted in gait velocity (53.6%), stride length (57.6%), step width (30.2%), and gait stability ratio (30.0%). For gait velocity, improvement from baseline at 1-, 6-, 12-, and 24-months was noted in 87.1%, 79.0%, 80%, and 77.6% of patients. For stride length, improvement from baseline at 1-, 6-, 12-, and 24-months was noted in 66.0%, 63.1%, 87.3%, and 79.3% of patients. For gait stability ratio improvement from baseline at 1-, 6-, 12-, and 24-months was noted in 87.2%, 82.4%, 91.8%, and 87.9% of patients. For gait cadence, improvement from baseline was observed in 68.8% of patients at 1-month, but such improvement was not demonstrated as statistically significant at 6- and 12-months with decline to 36.2% at 24-months.

Conclusions: Improvements in objective gait metrics are noted following VPS for iNPH with a plateau observed with longer term follow-up.