title: Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus.
abstract: BACKGROUND
  Early surgical series of shunt insertion for idiopathic normal-pressure hydrocephalus reported a low rate of short-term improvement with a relatively high rate of mortality and morbidity; subsequently shunt insertion was recommended for patients in whom there is favourable risk-to-benefit ratio.
  
  
  METHODS
  Bibliographic search for studies that objectively assessed the outcome following shunt insertion in idiopathic normal-pressure hydrocephalus was done; the aim was to estimate the outcome of shunt insertion in terms of improvement rates and associated mortality and morbidity.
  
  
  RESULTS
  A total of 64 studies of 3,063 patients were reviewed. Positive improvement following shunt insertion was reported in an average of 71 % of patients with an average 1 % mortality. Results from studies published in the last 5 years showed 82 % improvement following shunt insertion, mortality of 0.2 %, and combined common complications rate of 8.2 %.
  
  
  CONCLUSIONS
  When patients are properly selected, shunt insertion is a safe and effective management of idiopathic normal-pressure hydrocephalus with a prolonged positive outcome.
authors: Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, ahmedktoma@yahoo.com.
authors: Ahmed K
authors: AK
authors: Toma
authors: Marios C
authors: MC
authors: Papadopoulos
authors: Simon
authors: S
authors: Stapleton
authors: Neil D
authors: ND
authors: Kitchen
authors: Laurence D
authors: LD
authors: Watkins
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome