Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus--a systematic review

Abstract

Introduction: Treatment of idiopathic normal pressure hydrocephalus (iNPH) is challenging. It is well known that patients with iNPH experience short-term symptom relief after shunt implantation, but the long-term effect of shunting has yielded diverging results. The objective of the present study was to review the literature and to investigate the diagnostics, treatment and outcome of patients with iNPH after shunt treatment.

Methods: A PubMed search was performed and 430 articles were identified. The search was further limited to humans, language (English and Norwegian) and publication dates after 1990. A total of 343 articles were retrieved, and 43 of these articles were found to be applicable to the research question and were therefore screened. A total of ten articles were discarded after reviewing their abstracts as the articles were not relevant to the question of interest. Another ten articles were identified from the reference lists of the initial articles which yielded a total of 43 relevant articles. The main reason for exclusion of articles was a lack of match between the articles' search criteria and the research question herein.

Results: Approximately 40% of the studies were prospective. The overall success rate from surgical treatment varied from 30% to 90%. Direct comparison was hampered by the lack of a common protocol regarding symptoms and outcome. Factors suggestive of a good outcome were early diagnosis, gait disturbance as the predominant preoperative complaint, and a positive response to cerebrospinal fluid dynamic tests.

Conclusion: Shunting remains the preferred treatment, but endoscopic third ventriculostomy is reported as a possible alternative in some studies.