You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

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

Author Information

*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