title: Indications for endoscopic third ventriculostomy in normal pressure hydrocephalus.
abstract: BACKGROUND
  Controversies remain regarding the proper diagnostic studies and prediction of outcome in patients with normal pressure hydrocephalus (NPH), and their management remains controversial. We propose a preoperative assessment routine the aim of which is to correctly select NPH patients, and to differentiate between them in terms of surgical treatment, identifying probable endoscopic third ventriculostomy (ETV) responders.
  
  
  METHODS
  We prospectively considered a group of 44 patients with suspected NPH on the basis of clinical symptoms and neuroradiological evidence, who have undergone supplemental diagnostic testing (tap test, external lumbar drainage, cerebrospinal fluid outflow resistance [Rout] determination through lumbar and ventricular infusion test). All 44 of these patients were treated with either shunt procedures or ETV.
  
  
  RESULTS
  To choose the kind of treatment (shunt or ETV), we evaluated the individual response during infusion tests. The efficacy of both surgical techniques was approximately 70%, with a significantly lower complication rate for ETV.
  
  
  CONCLUSIONS
  We evaluated the correlation between the various tests and the postoperative outcomes both for shunting and for ETV. Rout proved useful for preoperative assessment and choice of treatment. In carefully selected patients, ETV had qualitative results similar to shunting, presenting significantly fewer complications.
authors: Department of Neurosurgery, C.T.O. Hospital, Turin, Italy. n.paidakakos@gmail.com
authors: Nikolaos
authors: N
authors: Paidakakos
authors: S
authors: S
authors: Borgarello
authors: M
authors: M
authors: Naddeo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome