{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:16:26Z","timestamp":1791483386350,"version":"4.3.4"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>To examine the effect of delayed compared to early planning of shunt surgery on survival, in patients with idiopathic normal pressure hydrocephalus (iNPH), a long\u2010term follow\u2010up case\u2013control study of patients exposed to a severe delay of treatment was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 2010\u20132011 our university hospital was affected by an administrative and economic failure that led to postponement of several elective neurosurgical procedures. This resulted in an unintentional delay of planning of treatment for a group of iNPH patients, referred to as iNPH<jats:sub>Delayed<\/jats:sub> (<jats:italic>n<\/jats:italic>\u00a0=\u00a033, waiting time for shunt surgery 6\u201324\u00a0months). These were compared to patients treated within 3 months, iNPH<jats:sub>Early<\/jats:sub> (<jats:italic>n<\/jats:italic>\u00a0=\u00a069). Primary outcome was mortality. Dates and underlying causes of death were provided by the Cause of Death Registry. Survival was analysed by Kaplan\u2013Meier plots and a Cox proportional hazard model adjusted for potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up time was 6.0\u00a0years. Crude 4\u2010year mortality was 39.4% in iNPH<jats:sub>Delayed<\/jats:sub> compared to 10.1% in iNPH<jats:sub>Early<\/jats:sub> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001). The adjusted hazard ratio in iNPH<jats:sub>Delayed<\/jats:sub> was 2.57; 95% confidence interval 1.13\u20135.83, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.024. Causes of death were equally distributed between the groups except for death due to malignancy which was not seen in iNPH<jats:sub>Delayed<\/jats:sub>\u00a0but in 4\/16 cases in iNPH<jats:sub>Early<\/jats:sub> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.044).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present data indicate that shunt surgery is effective in iNPH and that early treatment increases survival.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.14671","type":"journal-article","created":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T03:54:06Z","timestamp":1608004446000},"page":"1153-1159","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Early shunt surgery improves survival in idiopathic normal pressure hydrocephalus"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6797-6348","authenticated-orcid":false,"given":"Kerstin","family":"Andr\u00e9n","sequence":"first","affiliation":[{"name":"Hydrocephalus Research Unit Institute of Neuroscience and Physiology Department of Clinical Neuroscience Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Wikkels\u00f8","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit Institute of Neuroscience and Physiology Department of Clinical Neuroscience Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Hellstr\u00f6m","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit Institute of Neuroscience and Physiology Department of Clinical Neuroscience Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4997-5266","authenticated-orcid":false,"given":"Mats","family":"Tullberg","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit Institute of Neuroscience and Physiology Department of Clinical Neuroscience Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Jaraj","sequence":"additional","affiliation":[{"name":"Hydrocephalus Research Unit Institute of Neuroscience and Physiology Department of Clinical Neuroscience Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"},{"name":"Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000342"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2016.1229749"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-013-1835-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.11.JNS10967"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00046-0"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002193"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306117"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2012.01677.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000168185.29659.C5"},{"key":"e_1_2_10_11_1","unstructured":"ACME.ACME 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