Diagnosis and Treatment of Normal-Pressure Hydrocephalus Syndrome—an Update

Dear Colleagues,

Since the original description of normal-pressure hydrocephalus (NPH) syndrome by Hakim in 1964, there have been significant advancements in awareness among neurologists and neurosurgeons of NPH, as it is one of the few causes of reversible cognitive deteriorarion in the elderly population. The apparent increase in the prevalence of this disease is due, in part, to the growth in the number of older persons in developed countries. In addition, a better physiopathological understanding of this syndrome, the availability of better biomarkers of the disease, and better and more precise hardware for cerebrospinal fluid (CSF) shunting has reduced the morbidity of NPH-ameliorating surgery and improved the final outcome of these fragile patients. In patients with potential NPH syndrome, adequate screening and correct diagnosis are the first necessary steps, though the different available guidelines are somewhat contradictory in this regard. Once the diagnosis is done, the need to choose adequate hardware for shunting is the most important dilemma that the neurosurgeon faces, particularly since there are few evidence-based studies that show the superiority of any specific type of valve. However, the heterogeneous results of surgery reported in the literature in the last 25 years and the differences in the figures of significant post-surgical morbidity have raised some concerns, and even skepticism, among neurologists and neurosurgeons about the value of surgical treatment in these patients.

The goal of this Special Issue is to review controversial aspects regarding the screening methods, diagnostic tests, and treatment of patients with NPH that are relevant to individualizing treatment and improving outcomes after surgery. In addition, we review the different types of available hardware and discuss the advantages and disadvantages of the most frequently-used devices. We remark on the need for the neurosurgeon to be aware of the differences among commercially-available devices and to avoid the common mistake of choosing a one-size-fits-all system for this group of patients. The variables to take into account for selecting the most appropiate CSF device are discussed. Careful selection can reduce the risk of what has been named “shunt–patient mismatch”, which is the most important cause of increased surgical risks after surgery. With a more rational approach to shunting, we believe that we can increase the chances of a positive outcome and increase the quality of life of aged patients with this syndrome.

Prof. Dr. Maria A. Poca
Prof. Dr. Juan Sahuquillo
Guest Editors

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