What is an alternative treatment to shun surgery for normal pressure hydrocephalus (NPH)?

Updated: Oct 19, 2018
  • Author: Michael J Schneck, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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An alternative technique to shunt surgery is gaining some currency. This involves endoscopic third ventriculostomy (ETV). Although it has been previously used in noncommunicating hydrocephalus, its use has also been examined in patients with NPH.

One study examining this technique followed a series of 36 patients divided into a group of 29 patients with secondary communicating hydrocephalus and a group of 7 patients with normal pressure hydrocephalus. Sixteen (44.4%) of the patients had a previous ventriculoperitoneal shunt placement that presented with shunt malfunction. ETV was considered successful in 27 of 36 patients (75%). A Kaplan-Meier analysis revealed that the successful proportion of ETVs in secondary communicating hydrocephalus at 0.5, 1, and 3 months of follow-up was 0.83, 0.8, and 0.77, respectively; in the idiopathic NPH group, it was 0.83 initially and became stable at 0.66 after the first month. However, these results need to be replicated with larger series before the use of this technique is determined. [23]

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