From the Research
The primary treatment for Normal Pressure Hydrocephalus (NPH) is surgical placement of a ventriculoperitoneal (VP) shunt, with recent studies suggesting that endoscopic third ventriculostomy (ETV) may be a viable alternative with comparable outcomes 1. This procedure involves inserting a thin tube (catheter) into the brain ventricles to drain excess cerebrospinal fluid (CSF) into the peritoneal cavity of the abdomen, where it can be absorbed by the body. Before committing to surgery, patients typically undergo a diagnostic lumbar tap test or external lumbar drainage trial to predict shunt responsiveness. The success rate of shunt surgery varies, with approximately 60-80% of properly selected patients showing improvement in symptoms. Best results occur when treatment is initiated early, particularly within months of symptom onset. Programmable shunts are often used, allowing neurosurgeons to adjust the drainage rate non-invasively after implantation. Following surgery, patients require regular follow-up appointments to monitor shunt function and symptom improvement. Complications may include infection, over-drainage, subdural hematoma, or shunt malfunction, occurring in about 30% of cases. Physical therapy and occupational therapy are important adjunctive treatments to help regain function after shunt placement. NPH symptoms (gait disturbance, urinary incontinence, and cognitive decline) improve in reverse order of appearance, with gait typically improving first and cognitive symptoms last. Recent studies, such as the one published in 2025 2, aim to compare the effects of ETV and VPS in patients diagnosed with iNPH, which may provide further insight into the optimal treatment approach. However, based on the current evidence, VP shunt placement remains the standard of care for NPH, with ETV being considered as a potential alternative in selected cases 1. It is essential to weigh the benefits and risks of each treatment option and consider individual patient factors when making a decision. In terms of specific valve types, gravitational valves may be preferred over differential pressure valves due to their lower risk of overdrainage complications 3. Ultimately, the choice of treatment should be made on a case-by-case basis, taking into account the latest research and clinical guidelines. Further research is needed to fully understand the optimal treatment approach for NPH and to improve patient outcomes. Key considerations in the treatment of NPH include:
- Early diagnosis and treatment initiation
- Proper patient selection for surgery
- Choice of surgical procedure (VP shunt vs. ETV)
- Type of valve used (gravitational vs. differential pressure)
- Regular follow-up and monitoring of shunt function and symptom improvement
- Adjunctive therapies, such as physical and occupational therapy, to support recovery and rehabilitation.