From the Research
The primary treatment for normal pressure hydrocephalus (NPH) is surgical placement of a ventriculoperitoneal (VP) shunt, as approximately 75% of patients improve after shunt surgery, regardless of shunt type or location 1.
Overview of NPH Treatment
The procedure involves inserting a catheter into the brain's ventricles to drain excess cerebrospinal fluid (CSF) into the peritoneal cavity of the abdomen, where it can be absorbed by the body.
- The shunt system includes a one-way valve that regulates the flow of CSF to maintain appropriate pressure levels.
- Before proceeding with shunt surgery, patients typically undergo a diagnostic CSF tap test or extended lumbar drainage to predict their likelihood of responding to shunt placement.
- The surgery is most effective when performed on properly selected patients, with improvement in symptoms such as gait disturbance, urinary incontinence, and cognitive decline.
Considerations and Complications
- Shunt complications can occur in patients, including infection, obstruction, or overdrainage, so regular follow-up is essential 2.
- While medication therapy is not effective for treating NPH directly, some patients may benefit from temporary measures like repeated lumbar punctures if they are poor surgical candidates.
- Early intervention generally leads to better outcomes, particularly for gait symptoms which tend to respond most favorably to shunting.
- The radiographic pattern of disproportionately enlarged subarachnoid space hydrocephalus (DESH) predicts a positive response to permanent CSF diversion 1.
- MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images.