title: Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients.
abstract: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient.
  
  
  METHODS
  In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test.
  
  
  RESULTS
  We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies.
  
  
  CONCLUSIONS
  The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.
authors.affiliation: Neurosurgery Residency Program, Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo SP, Brazil. mafernoliv@yahoo.com.br
authors.forename: Matheus Fernandes de
authors.initials: MF
authors.lastname: Oliveira
authors.forename: Felippe
authors.initials: F
authors.lastname: Saad
authors.forename: Rodolfo Casimiro
authors.initials: RC
authors.lastname: Reis
authors.forename: José Marcus
authors.initials: JM
authors.lastname: Rotta
authors.forename: Fernando Campos Gomes
authors.initials: FC
authors.lastname: Pinto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome