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. 2002;2002(3):CD003157.
doi: 10.1002/14651858.CD003157.

Shunting for normal pressure hydrocephalus (NPH)

T Esmonde  1 , S Cooke
Affiliations

Shunting for normal pressure hydrocephalus (NPH)

T Esmonde et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Since the condition was first described in 1965, the syndrome of normal pressure hydrocephalus (NPH) has conventionally been managed by placement of a cerebrospinal fluid (CSF) shunt.

Objectives: To determine the effectiveness of shunting procedures in promoting stability or improvement in the neurological symptoms and signs of NPH.

Search strategy: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 26 June 2001 using the terms 'shunt*' and 'normal pressure hydrocephalus'.

Selection criteria: Studies included for analysis were those involving the placement of a CSF shunt for the treatment of NPH as part of a randomized controlled trial.

Data collection and analysis: No data matching the selection criteria were found.

Main results: No randomized controlled trials of shunt placement versus no shunt were found.

Reviewer's conclusions: There is no evidence to indicate whether placement of a shunt is effective in the management of NPH.

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Conflict of interest statement

None known.

References

References to studies excluded from this review

Black 1980 {published data only}
    1. Black PM. Idiopathic normal pressure hydrocephalus Results of shunting in 62 patients. Journal of Neurosurgery 1980;52:371‐7. - PubMed
Boon 1994 {published data only}
    1. Boon AJW, Tans TH, Wurzer AL, Poortvliet DCJ. Dutch Normal Pressure Hydrocephalus Study Part II. Comparison of low and medium pressure shunts. Intracranial Pressure 1994;unknown:unknown.
Boon 1998 {published data only}
    1. Boon AJ, Tans JT, Delwel EJ, Egeler Peerdeman SM, Hanlo PW, Wurzer HA, et al. Dutch Normal‐Pressure Hydrocephalus Study: randomized comparison of low‐ and medium‐pressure shunts. Journal of Neurosurgery 1998;88(3):490‐5. - PubMed
Chaudhry 2007 {published data only}
    1. Chaudhry P, Kharkar S, Heidler‐Gary J, Hillis AE, Newhart M, Kleinman JT, et al. Characteristics and reversibility of dementia in Normal Pressure Hydrocephalus. Behavioural Neurology 2007;18(3):149‐58. - PMC - PubMed
Chen 1994 {published data only}
    1. Chen IH, Huang CI, Liu HC, Chen KK. Effectiveness of shunting in patients with normal pressure hydrocephalus predicted by temporary, controlled‐resistance, continuous lumbar drainage: a pilot study. Journal of Neurology, Neurosurgery & Psychiatry 1994;57(11):1430‐2. - PMC - PubMed
Czosnyka 2000 {published data only}
    1. Czosnyka Z, Czosnyka M, Copeman J, Pickard JD, Pollack IF. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus [2] (multiple letters). Neurosurgery 2000;47(5):1250‐1. - PubMed
De Jong 2000 {published data only}
    1. Jong DA, Delwel EJ, Avezaat CJ. Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochirurgica 2000;142(3):241‐7. - PubMed
Duplessis 1991 {published data only}
    1. Duplessis E, Decq P, Barat JL, Leguerinel C, Gendrault P. Treatment of chronic hydrocephalus in adults by flow‐regulated shunt. Apropos of a series of 46 patients. Neurochirurgie 1991;37(1):40‐3. - PubMed
Keifer 2006 {published data only}
    1. Keifer M, Meier U, Eymann R. Gravitational valves: relevant differences with different technical solutions to counteract hydrostatic pressure. Acta Neurochirurgica. Supplementum 2006:96343‐7. - PubMed
Meier 2006 a {published data only}
    1. Meier U, Keifer M, Neumann U, Lemcke J. On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal pressure hydrocephalus: a prospective randomised study with 123 patients. Acta Neurochirurgica. Supplementum 2006:96358‐63. - PubMed
Meier 2006 b {published data only}
    1. Meier U. First clinical experiences in patients with idiopathic normal pressure hydrocephalus with the adjustable gravity valve manufactured by Aesculap (proGAV (Aesculap)). Acta Neurochirurgica. Supplementum 2006:96368‐72. - PubMed
Meier 2006 c {published data only}
    1. Meier U, Lemcke J. Clinical outcome of patients with idiopathic normal pressure hydrocephalus three years after shunt implantation. Acta Neurochirurgica. Supplementum 2006:96377‐80. - PubMed
Miyamoto 2007 {published data only}
    1. Miyamoto J, Imahori Y, Mineura K. Cerebral oxygen metabolism in idiopathic normal pressure hydrocephalus. Neurological Research 2007;29(8):830‐4. - PubMed
Pickard 1982 {published data only}
    1. Pickard JD. Adult communicating hydrocephalus. British Journal of Hospital Medicine 1982;27(1):35, 37‐8, 40. - PubMed
Pollack 1999 {published data only}
    1. Pollack IF, Albright AL, Adelson PD. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim‐Medos Investigator Group. Neurosurgery 1999;45(6):1399‐408; discussion 1408‐11. - PubMed
Silverberg 2000 {published data only}
    1. Silverberg GD, Bloch D, Kahle P, McGuire D, Saul TA, Shooter E, et al. Effects of chronic CSF drainage on cognition and concentration of biochemical markers in Alzheimer's disease: report of a phase I clinical trial. Conference Proceedings World Alzheimer Congress; 9‐13 July, 2000; Washington. 2000.
Tans 1999 {published data only}
    1. Tans JTJ, Boon AJW. Normal Pressure Hydrocephalus. Indications for Shunting. 11th European Congress of Neurosurgery. 1999:641‐5.
Williams 2008 {published data only}
    1. Williams MA, Thomas G, deLateur B, Imteyaz H, Rose JG, Shore WS, et al. Objective assessment of gait in normal‐pressure hydrocephalus. American Journal of Physical Medicine and Rehabilitation 2008;87(1):39‐45. - PubMed

Additional references

Adams 1997
    1. Adams V, Ropper editors. Principles of neurology. 6th Edition. New York: McGraw‐Hill, 1997.
Hakim 1965
    1. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Journal of Neurological Sciences 1965;2:307. - PubMed

References to other published versions of this review

Esmonde 2002
    1. Esmonde T, Cooke S. Shunting for normal pressure hydrocephalus (NPH). Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD003157] - DOI - PMC - PubMed

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