From the Research
The primary medical treatment for Normal Pressure Hydrocephalus (NPH) is surgical placement of a lumboperitoneal (LP) shunt, as it has been shown to be a safe and effective alternative to ventriculoperitoneal (VP) shunting, with similar curative effects and a lower risk of complications, as demonstrated in the most recent study 1. This procedure involves inserting a thin tube (catheter) into the lumbar cistern to drain excess cerebrospinal fluid (CSF) from the brain to the peritoneal cavity in the abdomen, where it can be absorbed. The shunt system includes a valve that regulates the flow and pressure of CSF. Patients typically undergo a comprehensive evaluation before shunt placement, including a CSF drainage trial (lumbar tap test or external lumbar drainage) to predict response to shunting. After surgery, patients require regular follow-up to monitor shunt function and may need adjustments to the valve settings to optimize drainage. Surgery is recommended because NPH results from impaired CSF absorption or flow, causing ventricular enlargement and compression of brain tissue. Unlike many neurological conditions, NPH can be reversible with proper treatment, with improvement in the classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, as shown in studies 2, 3. Medication alone is not effective for treating the underlying cause of NPH. Some key benefits of LP shunts include avoiding intraparenchymal hemorrhage (IPH) caused by ventricular puncture and increasing the right first time (RFT) rate, as reported in 1. However, it's essential to consider the potential risks and complications associated with LP shunts, such as shunt malfunctions and revisions, as noted in 2, 4, 5. Overall, the decision to use an LP shunt or a VP shunt should be based on individual patient needs and circumstances, taking into account the latest evidence and clinical guidelines. In terms of specific outcomes, studies have shown that LP shunts can lead to significant improvements in gait, urinary continence, and cognitive function, as well as a reduction in periventricular white matter hyperintensities, as demonstrated in 3. Therefore, LP shunts are a viable and effective treatment option for patients with NPH, offering a minimally invasive alternative to traditional VP shunting, with comparable efficacy and safety profiles, as supported by the most recent and highest-quality evidence 1.