Shunting for idiopathic normal pressure hydrocephalus

Area of Science:

• Neurosurgery
• Neurology
• Clinical Trials

Background:

• Idiopathic normal pressure hydrocephalus (iNPH) is characterized by enlarged brain ventricles leading to gait, cognitive, and urinary impairments.
• While non-randomized studies suggest benefits of cerebrospinal fluid (CSF) shunting, robust randomized controlled trial (RCT) data have been limited.

Approach:

• This study systematically reviewed RCTs comparing CSF-shunting to no shunting in iNPH patients.
• Searches were conducted across multiple databases up to February 2023, including ClinicalTrials.gov and WHO ICTRP.
• Four RCTs involving 140 participants were included, with three contributing to a meta-analysis.

Key Points:

• CSF-shunting likely improves gait speed (moderate certainty) and reduces disability (moderate certainty) within six months post-surgery.
• Evidence regarding the impact of CSF-shunting on cognitive function is very uncertain.
• Data on adverse events and quality of life following CSF-shunting are very limited or absent.

Conclusions:

• CSF-shunting demonstrates probable short-term benefits for gait speed and disability in iNPH.
• Further research is essential to clarify the effects on cognition, adverse events, and long-term outcomes.
• More data are needed on patient ethnicity and the impact on quality of life.