Continuous intraventricular pressure monitoring for diagnosis of normal-pressure hydrocephalus

Acta Neurochir (Wien). 2007 Oct;149(10):983-90; discussion 990. doi: 10.1007/s00701-007-1240-z. Epub 2007 Aug 6.


Objectives: Normal-pressure hydrocephalus (NPH) syndrome is treatable by implantation of a cerebrospinal fluid (CSF) shunt. However, diagnosis of NPH by clinical and radiological findings alone is unreliable, and co-existing structural dementia can contribute to low success rates after shunt implantation. The aim of our study was to investigate whether long-term results after shunt implantation in NPH improve when surgical candidates are selected by continuous intraventricular pressure monitoring (CIPM).

Patients and methods: Ninety-two consecutive patients who were admitted with suspected NPH received CIPM for 48 h including an intraventricular steady-state infusion test to determine the resistance outflow. With positive CIPM, shunt implantation was performed and the patients were prospectively followed up for 1 to 10 years (median 6.5 years).

Results: CIPM was negative in 37 patients. Fifty-five patients had a positive CIPM and received CSF shunt. 96.1% of them improved from gait disturbance, 77.1% from cognitive impairment and 75.7% from urinary dysfunction. Clinical improvement remained during long-term follow-up in all but 3 patients who showed a decline at 4, 5 and 7 years, respectively. CIPM-related complications (ventriculitis) occurred in only one patient.

Conclusion: CIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.

MeSH terms

  • Cerebrospinal Fluid Shunts
  • Dementia / etiology
  • Dementia / surgery
  • Follow-Up Studies
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / surgery
  • Humans
  • Hydrocephalus, Normal Pressure / diagnosis*
  • Hydrocephalus, Normal Pressure / etiology
  • Hydrocephalus, Normal Pressure / physiopathology
  • Hydrocephalus, Normal Pressure / surgery
  • Magnetic Resonance Imaging
  • Monitoring, Physiologic
  • Neurologic Examination
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Prospective Studies
  • Recurrence
  • Spinal Puncture
  • Tomography, X-Ray Computed
  • Urinary Incontinence / etiology
  • Urinary Incontinence / surgery
  • Ventricular Pressure / physiology*