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Updated: Oct 21, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Protocolizing the Workup for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes.
Lealani Mae Y Acosta1, Kassandra Stubblefield1, Trisha Conwell1
1Department of Neurology (LMYA, KS, KE, H. Koons, JF, H. Kirshner, TD) and Department of Neurosurgery (TC), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurosurgery (PK), West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV.
A new protocol for idiopathic normal pressure hydrocephalus (INPH) improves patient selection for shunting. This leads to better gait outcomes in patients receiving ventriculoperitoneal shunts.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Protocol Development
Background:
- Idiopathic normal pressure hydrocephalus (INPH) diagnosis and shunting candidate selection are challenging.
- Current workup coordination for INPH can be difficult.
- A formalized protocol may enhance patient selection for ventriculoperitoneal shunting.
Purpose of the Study:
- To evaluate the impact of a standardized INPH assessment protocol on patient selection and outcomes.
- To compare the effectiveness of a new protocol versus pre-protocol (PP) patient management.
- To determine if protocol implementation improves outcomes related to shunting.
Main Methods:
- A cohort of 40 patients managed under a new INPH protocol was compared to 26 patients managed pre-protocol.
- Key measures included baseline deficits, diagnostic workup (e.g., high-volume lumbar puncture, gait/cognitive assessments), neurosurgical evaluation, and shunt response.
- Statistical analysis was used to compare outcomes between the two groups.
Main Results:
- Protocol patients underwent significantly more high-volume lumbar punctures (HVLP), formalized gait assessments, and standardized cognitive testing.
- A higher percentage of protocol patients showed no improvement after HVLP, leading to fewer receiving shunts.
- While shunt recipients in the protocol group showed improved gait, cognitive and incontinence improvements were not significantly different compared to the pre-protocol group.
Conclusions:
- Implementation of an INPH protocol standardizes and expands patient assessment.
- The protocol improves patient selection for shunting, particularly for gait-related symptoms.
- Enhanced assessment under the protocol leads to better outcomes from ventriculoperitoneal shunting.
