title: Role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial.
abstract: 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%).
  
  
  CONCLUSIONS
  Compared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.
authors: Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
authors: Fernando Campos Gomes
authors: FC
authors: Pinto
authors: Felippe
authors: F
authors: Saad
authors: Matheus Fernandes de
authors: MF
authors: Oliveira
authors: Renan Muralho
authors: RM
authors: Pereira
authors: Fernanda Letkaske de
authors: FL
authors: Miranda
authors: Juliana Benevenuto
authors: JB
authors: Tornai
authors: Maria Izabel Romão
authors: MI
authors: Lopes
authors: Eduardo Santamaria Carvalhal
authors: ES
authors: Ribas
authors: Emilia Aparecida
authors: EA
authors: Valinetti
authors: Manoel Jacobsen
authors: MJ
authors: Teixeira
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*