Idiopathic Normal Pressure Hydrocephalus Treatment

• Causal associations between gut microbiota, metabolites, and idiopathic normal pressure hydrocephalus: a two-sample Mendelian randomization study
• Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement
• Clinical Features and Diagnosis of Normal Pressure Hydrocephalus
• Value of biomarkers in the prediction of shunt responsivity in patients with normal pressure hydrocephalus
• Extended lumbar drain trials for diagnostic evaluation of idiopathic normal pressure hydrocephalus with the Berg Balance Scale
• The Effects of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt on Neuropsychological and Motor Performance in Patients with Idiopathic Normal Pressure Hydrocephalus-ENVENTOR-iNPH: Study Protocol
• Programmable gravitational valves in idiopathic normal pressure hydrocephalus: long-term outcomes after a 3-year follow-up
• Advancing treatment strategies for idiopathic normal pressure hydrocephalus: a systematic review on studies comparing ventricular and lumbo-peritoneal shunts

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a potentially reversible cause of dementia and gait disturbance in the elderly. Its treatment requires accurate diagnosis, careful patient selection, and long-term follow-up.

• Ventriculoperitoneal shunt: Most common technique.
• Lumboperitoneal shunt: Alternative with no need for craniotomy.
• Ventriculoatrial shunt: Rarely used due to higher thrombotic risk.

• Preferred over fixed-pressure valves to minimize complications (e.g., overdrainage).
• Adjustable Valves allow postoperative pressure adjustments based on clinical evolution.

• Anti-siphon Devices Help prevent overdrainage, especially in upright posture.

• Gait disturbance is the most responsive symptom.
• Positive response to CSF tap test or external lumbar drainage increases likelihood of improvement after shunt.
• MRI features: Enlarged ventricles (Evans’ index >0.3), tight high-convexity sulci, and callosal angle <90° support the diagnosis.

• Up to 80% of well-selected patients show clinical improvement after shunt.
• Gait improves more frequently than cognition or urinary symptoms.
• Cognitive response is variable and often incomplete.

• Shunt malfunction (obstruction, disconnection)
• Overdrainage (subdural hematomas, slit ventricle syndrome)
• Infection
• Abdominal complications (e.g., pseudocyst, obstruction)

• Clinical follow-up: Monitor gait, cognitive function, and urinary symptoms.
• Imaging: Brain CT or MRI to check ventricular size and rule out complications.
• Valve adjustment if needed (in programmable valves).

• Physical rehabilitation post-shunt may enhance gait recovery.
• No effective pharmacological therapy for iNPH.
• Cognitive training may help in selected cases.

• Patients with significant comorbidities may not be ideal surgical candidates.
• Differential diagnosis includes Alzheimer's disease, Parkinson's disease, and vascular dementia.
• Multidisciplinary evaluation (neurosurgeon, neurologist, geriatrician) is recommended.

Cerebrospinal fluid shunting with adjustable differential pressure valve is the treatment of idiopathic normal pressure hydrocephalus.

The most commonly used is the implantation of a ventriculoperitoneal shunt ¹⁾.

Shunt surgery has been established as the only durable and effective treatment for idiopathic normal pressure hydrocephalus

To maximise the benefits of shunt treatment, surgery should be performed soon after diagnosis ²⁾.

A single session of Action observation is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients ³⁾.

The results of a prospective multicentre study on patients with iNPH diagnosed solely on clinical and radiological criteria support shunt surgery in patients presenting with symptoms and signs and MRI findings suggestive of iNPH ⁴⁾.

see Shunt for Idiopathic normal pressure hydrocephalus treatment.

see Endoscopic third ventriculostomy for idiopathic normal pressure hydrocephalus.

see Idiopathic normal pressure hydrocephalus treatment complications.