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Predictors of shunt responsiveness and outcomes in idiopathic normal pressure hydrocephalus: a retrospective cohort study

Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Idiopathic Normal Pressure Hydrocephalus (iNPH) remains a challenging clinical diagnosis with variable treatment response. OBJECTIVES: This study aimed to identify clinical, imaging, and CSF biomarkers associated with favorable outcomes following shunt placement. METHODS: All patients evaluated for iNPH at the Tel-Aviv Medical Center (TLVMC) between 2020 and 2022 were included. Participants underwent clinical, cognitive, and imaging assessments, high-volume lumbar puncture (LP). LP responders were referred for shunt placement, and outcomes assessed at one year. RESULTS: 183 patients were evaluated; 167 met criteria for suspected iNPH and underwent LP. Sixty-two (37%) patients showed improvement after CSF drainage and were referred for shunting. Of these, 38 (61%) underwent shunt placement. Gait disturbance was the most common presenting symptom (68%), and more frequent in LP responders (p = 0.007), whereas cognitive symptoms were more common among non-responders (29.5% vs. 10%). LP responders had lower CSF total tau (t-tau) (222.6 ± 99.1 vs. 256 ± 107.1, p = 0.045) and protein (41.1 ± 17.1 vs. 49.1 ± 25.7, p = 0.032) and were more likely to exhibit a disproportionately enlarged subarachnoid-space hydrocephalus (DESH) pattern (73% vs. 46%, p < 0.001). Among the 38 shunted patients, 21 (55%) had a favourable outcome at one year, which was associated with lower t-tau (p = 0.056) and more frequent DESH (p = 0.026). CONCLUSIONS: Over half of patients who underwent shunt placement experienced favorable clinical outcomes at one year. Lower t-tau and DESH pattern were associated with better outcomes.
DOI: 10.1007/s00701-026-06839-x
Language: English
Open Access status: gold
Estimated APC paid: $3,990
OpenAlex ID: W7140139007
FWCI: 2.376
Cites: 42
Cited by: 1
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