HYDROCEPHALUS IN RADIATION LEUKOENCEPHALOPATHY - RESULTS OF VENTRICULOPERITONEAL SHUNTING

Objective: To assess the clinical benefit of ventriculoperitoneal shun ting in patients suffering from radiotherapy-induced leukoencephalopat hy. Design: Retrospective review of a single institutional experience. Patients: Thirty-one patients with the postradiotherapy syndrome rece ived ventriculoperitoneal shunts. All had a history of cranial irradia tion, progressive ventriculomegaly visible on neuroimaging scans, and neurologic decline; other causes of hydrocephalus were excluded. All 3 1 patients had cognitive deficits: 30 had gait disturbance and 24 were incontinent. Results: Twenty-four (80%) of 30 assessable patients ach ieved symptomatic improvement an average of 1.6 months after ventricul operitoneal shunting. Incontinence and gait problems were more likely to improve than cognition. Sixteen (53%) of 30 patients achieved a goo d overall functional outcome, and incontinence was the only feature si gnificantly associated with good outcome (P=.04). Neither cerebrospina l fluid-opening pressure nor tap tests predicted improvement from vent riculoperitoneal shunting. Median duration of improvement was 6 months , and median survival after receiving the shunt was 14.5 months. Shunt -related complications occurred in 10 (33%) of 30 patients, with 1 fat al outcome. Conclusions: Our results from ventriculoperitoneal shuntin g in selected patients with radiation-induced hydrocephalus suggest po tential benefit. Improvement is incomplete and temporary, but can impr ove quality of life. Reliable predictors of successful shunt outcome w ere not identified.