Treatment of Normal Pressure Hydrocephalus (NPH)

Diagnosis and Patient Selection

Diagnosis should be confirmed with MRI with contrast to evaluate for ventriculomegaly and to rule out other causes, as recommended by the American Academy of Neurology 1

Endoscopic Third Ventriculostomy (ETV) has emerged as an alternative to VP shunts for treating hydrocephalus in selected patients, according to the American Association of Neurological Surgeons 1
When adjusted for patient age and etiology, ETV has higher early failure rates than shunts but lower failure rates after 3 months, with a strength of evidence of Level II 2
Both CSF shunts and ETV demonstrate equivalent overall outcomes in many clinical scenarios, with a strength of evidence of Level II, as stated by the Congress of Neurological Surgeons 3

Routine use of serial lumbar punctures is not recommended as a definitive treatment, with a strength of evidence of Level I, according to the American Association of Neurological Surgeons 4