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: firstname.lastname@example.org
Received May 18, 2012
Accepted December 18, 2012