The Predictive Value of Cerebrospinal Fluid Dynamic Tests in Patients With the Idiopathic Adult Hydrocephalus Syndrome

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

“…The efficacy of shunt procedures maintained for the short term ranged from 3-6 months in 64-96% of patients, 2,5,15,21,22,24,32,35,36,48) and at 1 year in 41-95% 10,12,18,25,33,40,49,50,62,66) ; while the efficacy of shunt procedures maintained for the long term ranged from 3-5 years in 28-91% of patients. 2,9,21,32,36,38,46,49,50,52) The best improvement rate was for gait disturbance, between 58-90%. 2,5,14,21,32,35,36,45,49,50,52,66) The improvement rate for dementia differed with the evaluation scale used; however, the symptoms improved in 29-80% of patients.…”

“…It is controversial whether the above imaging diagnosis predicts the shunt response, 23,24,32,41,72) but measurements of the preoperative peak flow velocity of CSF 103,122) and stroke volume, reflecting the CSF volume following the cerebral aqueduct, 6,120,121) have been reported to be clinically useful predictors of the shunt response, and these may be considered for preoperative examinations; however, the measurement methods have not been standardized and their diagnostic value has not been established. Reduced venous circulation in the sagittal and straight sinuses and intracranial compliance on heart rate-gated phase-contrast MRI have been reported, 11,12) but their diagnostic values have not been established.…”

“…The surgical procedures for iNPH are the same as those for other types of communicating hydrocephalus: ventriculo-peritoneal shunt, 9,11,18,25,32,45,46,66) ventriculo-atrial shunt, 9,25,46) and lumbo-peritoneal shunt. 45,47,53) As for the historical view in the treatment of hydrocephalus, a ventriculo-atrial shunt was often performed on patients with iNPH in the past, whereas a ventriculo-peritoneal shunt is currently preferred.…”

“…No studies have directly compared these surgical procedures in terms of efficacy for the treatment of iNPH. Approximately 50-90% 9,11,18,25,32,[45][46][47]66) of cases reportedly improve after these shunting operations, and little difference between them is apparent in the management of iNPH (Recommendation grade B).…”

“…However, reports have shown that there are no major differences between the valves in terms of complication rates of infection 30,51,55,68) or shunt occlusion. 32,55,56,67) However, the use of antibiotics during the perioperative period has been shown to reduce the incidence of infection. 67) Complications of nontraumatic subdural hygroma/hematoma were reported to improve by resetting to higher pressures in the Codman-Hakim Programmable Valve } and Sophy Valve } , and evacuative operations were only required in 2.7% of cases using the Codman-Hakim Programmable Valve } 51,68) and 1.4% using the Sophy Valve } .…”