Acta Neurochirurgica

, Volume 155, Issue 10, pp 1977–1980 | Cite as

Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus

  • Ahmed K. Toma
  • Marios C. Papadopoulos
  • Simon Stapleton
  • Neil D. Kitchen
  • Laurence D. Watkins
Review Article - Functional



Early surgical series of shunt insertion for idiopathic normal-pressure hydrocephalus reported a low rate of short-term improvement with a relatively high rate of mortality and morbidity; subsequently shunt insertion was recommended for patients in whom there is favourable risk-to-benefit ratio.


Bibliographic search for studies that objectively assessed the outcome following shunt insertion in idiopathic normal-pressure hydrocephalus was done; the aim was to estimate the outcome of shunt insertion in terms of improvement rates and associated mortality and morbidity.


A total of 64 studies of 3,063 patients were reviewed. Positive improvement following shunt insertion was reported in an average of 71 % of patients with an average 1 % mortality. Results from studies published in the last 5 years showed 82 % improvement following shunt insertion, mortality of 0.2 %, and combined common complications rate of 8.2 %.


When patients are properly selected, shunt insertion is a safe and effective management of idiopathic normal-pressure hydrocephalus with a prolonged positive outcome.


Cerebrospinal fluid Curable dementia Idiopathic normal-pressure hydrocephalus Outcome Shunt 



The clinical research fellow post at Victor Horsley department of Neurosurgery is supported by a grant from B Braun Medical Ltd. We are grateful to the staff of Rockefeller Medical Library of the UCL Institute of Neurology & National Hospital for Neurology and Neurosurgery for their help in providing the review articles.

Conflicts of interest

The position of clinical research fellow at the adult hydrocephalus service is supported by a grant from B. Braun Medical, Ltd.

Supplementary material

701_2013_1835_MOESM1_ESM.doc (96 kb)
ESM 1 (DOC 96 kb)
701_2013_1835_MOESM2_ESM.doc (337 kb)
ESM 2 (DOC 337 kb)


  1. 1.
    Adams RD (1975) Recent observations on normal pressure hydrocephalus. Schweiz Arch Neurol Neurochir Psychiatr 116:7–15PubMedGoogle Scholar
  2. 2.
    Bergsneider M, Black PML, Klinge P, Marmarou M, Relkin N (2005) INPH guidelines, part IV: surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S2-29–S2-39Google Scholar
  3. 3.
    Boon AJW, Tans JTJ, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1998) Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low-and medium-pressure shunts. J Neurosurg 88:490–495PubMedCrossRefGoogle Scholar
  4. 4.
    Brecknell JE, Brown JI (2004) Is idiopathic normal pressure hydrocephalus an independent entity? Acta Neurochir 146:1003–1006PubMedCrossRefGoogle Scholar
  5. 5.
    De Jong D, Delwel E, Avezaat C (2000) Hydrostatic and hydrodynamic considerations in shunted normal pressure hydrocephalus. Acta Neurochir 142:241–247PubMedCrossRefGoogle Scholar
  6. 6.
    Esmonde T, Cooke S (2002) Shunting for normal pressure hydrocephalus (NPH). Cochrane Database Syst Rev 3:CD003157Google Scholar
  7. 7.
    Hakim S, Adams R (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:307–327PubMedCrossRefGoogle Scholar
  8. 8.
    Hebb AO, Cusimano MD (2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186PubMedGoogle Scholar
  9. 9.
    Ishikawa M, Hashimoto M, Kuwana N, Mori E, Miyake H, Wachi A, Takeuchi T, Kazui H, Koyama H (2008) Guidelines for management of idiopathic normal pressure hydrocephalus. Neurol Med 48:1–23CrossRefGoogle Scholar
  10. 10.
    Jones HC, Klinge PM (2008) Hydrocephalus 2008, 17-20th September, Hannover Germany: a conference report. Cerebrospinal Fluid Res 16:5–19Google Scholar
  11. 11.
    Judge A, Chard J, Learmonth I, Dieppe P (2006) The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England. Journal of Public Health 28:116PubMedCrossRefGoogle Scholar
  12. 12.
    Kiefer M, Eymann R, Steudel WI (2006) Outcome predictors for normal-pressure hydrocephalus. Acta Neurochir Suppl 96:364–367PubMedCrossRefGoogle Scholar
  13. 13.
    Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PML (2005) INPH guidelines, part V: outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery 57:S2-40–S2-52Google Scholar
  14. 14.
    Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PML (2005) INPH guidelines, part III: the value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S2-17–S2-28CrossRefGoogle Scholar
  15. 15.
    Marmarou A, Bergsneider M, Relkin N, Klinge P, Black PM (2005) INPH guidelines, part I: development of guidelines for idiopathic normal-pressure hydrocephalus: Introduction. Neurosurgery 57:S2-1–S2-3CrossRefGoogle Scholar
  16. 16.
    Pujari S, Kharkar S, Metellus P, Shuck J, Williams MA, Rigamonti D (2008) Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry 79:1282–1286PubMedCrossRefGoogle Scholar
  17. 17.
    Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PML (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S2CrossRefGoogle Scholar
  18. 18.
    Ryge C, Lassen M, Solgaard S, Sonne-Holm S (2010) Mortality and morbidity following total hip arthroplasty. JBJS (Br) 92:310Google Scholar
  19. 19.
    Stein SC, Burnett MG, Sonnad SS (2006) Shunts in normal-pressure hydrocephalus: do we place too many or too few? J Neurosurg 105:815–822PubMedCrossRefGoogle Scholar
  20. 20.
    Williams O, Fitzpatrick R, Hajat S, Reeves BC, Stimpson A, Morris RW, Murray DW, Rigge M, Gregg PJ (2002) Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty. J Arthroplast 17:165–171CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Ahmed K. Toma
    • 1
  • Marios C. Papadopoulos
    • 2
  • Simon Stapleton
    • 2
  • Neil D. Kitchen
    • 1
  • Laurence D. Watkins
    • 1
  1. 1.Victor Horsley Department of NeurosurgeryThe National Hospital for Neurology and NeurosurgeryLondonUK
  2. 2.Academic Neurosurgery UnitSt George’s University of LondonLondonUK

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