Can stereotactic radiosurgery treat idiopathic normal pressure hydrocephalus? literature-based evidence

Idiopathic normal pressure hydrocephalus (iNPH) is a common and potentially reversible cause of gait disturbance, cognitive decline, and urinary incontinence in the elderly, with current treatments relying primarily on cerebrospinal fluid (CSF) diversion procedures that are associated with notable complications and failure rates. The choroid plexus, as the principal site of CSF production, represents a biologically plausible therapeutic target. Stereotactic radiosurgery (SRS) offers a non-invasive approach for precise ablation of the central nervous system pathologies; however, its role in iNPH has not been systematically explored. This review examines the biological rationale, experimental evidence, and potential clinical applicability of radiosurgical ablation of the choroid plexus for iNPH, while identifying existing limitations and future research directions. Nonetheless, critical gaps remain, including an incomplete understanding of the mechanisms of action, the absence of dose-response data, a lack of standardized treatment protocols, and unknown clinical outcomes and adverse event profiles. Further preclinical studies, particularly in larger animal models, are required to refine dosimetry, clarify biological effects, and assess safety, ultimately informing the design of prospective clinical trials to determine the feasibility and efficacy of SRS as a potential non-invasive therapeutic option for iNPH.