title: Evidences in the treatment of idiopathic normal pressure hydrocephalus.
abstract: BACKGROUND
  idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment.
  
  
  METHODS
  an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment.
  
  
  RESULTS
  the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard.
  
  
  CONCLUSIONS
  well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.
authors.affiliation: Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil.
authors.forename: Matheus Fernandes de
authors.initials: MF
authors.lastname: Oliveira
authors.affiliation: IAMSPE, São Paulo, SP, Brazil.
authors.forename: Rodolfo Casimiro
authors.initials: RC
authors.lastname: Reis
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Evelinda Marramon
authors.initials: EM
authors.lastname: Trindade
authors.affiliation: FM, USP, São Paulo, SP, Brazil.
authors.forename: Fernando Campos Gomes
authors.initials: FC
authors.lastname: Pinto
mesh_terms: D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods; D014696:Ventriculostomy / Q000379:methods