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Role of Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunt in Idiopathic Normal Pressure Hydrocephalus: Preliminary Results of a Randomized Clinical Trial

Pinto, Fernando Campos Gomes PhD*; Saad, Felippe MD*; Oliveira, Matheus Fernandes de MD; Pereira, Renan Muralho§; Miranda, Fernanda Letkaske de MD*; Tornai, Juliana Benevenuto MD*; Lopes, Maria Izabel Romão MD*; Ribas, Eduardo Santamaria Carvalhal MD*; Valinetti, Emilia Aparecida PhD*; Teixeira, Manoel Jacobsen PhD*

doi: 10.1227/NEU.0b013e318285b37c
Research-Human-Clinical Trials

BACKGROUND: Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation.

OBJECTIVE: To compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS.

METHODS: Randomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus.

RESULTS: There was a statistically significant difference between the 2 groups after 12 months of follow-ups, and the VPS group showed better improvement results (ETV = 50%, VPS = 76.9%).

CONCLUSION: Compared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.

ABBREVIATIONS: BERG, Berg balance scale

DGI, dynamic gait index

EI, Evans index

ETV, endoscopic third ventriculostomy

FIM, functional independence measure

INPH, idiopathic normal pressure hydrocephalus

MMSE, Mini-Mental State Examination

NPH Scale, NPH Japanese Scale

TT, tap test

TUG, timed up and go

VPS, ventriculoperitoneal shunt

*Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil;

Neurosurgery Residency Program, Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil;

§Neurosurgery League, Faculty of Medicine, University of Sao Paulo and medical student at Universidade Anhembi-Morumbi, São Paulo, Brazil

Correspondence: Fernando Campos Gomes Pinto, PhD, Av Angélica, 1968, cj.21, São Paulo, SP. Brazil, CEP 01228-200. E-mail:

Received May 18, 2012

Accepted December 18, 2012

Copyright © by the Congress of Neurological Surgeons