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Review
. 2025 Jun 1;31(3):840-849.
doi: 10.1212/cont.0000000000001569.

Management of Normal Pressure Hydrocephalus

Kaisorn L Chaichana, Jeremy K Cutsforth-Gregory
Review

Management of Normal Pressure Hydrocephalus

Kaisorn L Chaichana et al. Continuum (Minneap Minn). .

Abstract

Objective: This article reviews the preoperative considerations, postoperative complications, and ongoing management of shunts for normal pressure hydrocephalus.

Latest developments: The radiographic pattern of disproportionately enlarged subarachnoid space hydrocephalus (DESH) predicts a positive response to permanent CSF diversion. MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images. Endoscopic third ventriculostomy is a viable alternative to shunting for patients with normal pressure hydrocephalus due to aqueductal stenosis.

Essential points: Approximately 75% of patients with normal pressure hydrocephalus improve after shunt surgery regardless of shunt type or location. Clinical benefit and complication rates are similar for frontal and parietal ventricular catheter approaches. Acetazolamide is not an effective treatment for normal pressure hydrocephalus.

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