title: [Long-term prognosis of idiopathic chronic adult hydrocephalus: I. The University Hospital Marqués de Valdecilla diagnostic and therapeutic protocol].
abstract: BACKGROUND
  Despite the existence of published guidelines for more than a decade, there is still a substantial variation in the management of idiopathic normal pressure hydrocephalus due to its diagnostic and therapeutic complexity.
  
  
  METHODS
  The diagnostic and therapeutic protocol for the management of idiopathic normal pressure hydrocephalus in use at the Department of Neurosurgery of the University Hospital Marqués de Valdecilla is presented. The diagnostic process includes neuropsychological testing, phase contrast cine MRI, urodynamic evaluation, continuous intracranial pressure monitoring, cerebrospinal fluid hydrodynamics by means of lumbar infusion testing, and intra-abdominal pressure measurement. A patient is considered a surgical candidate if any of the following criteria is met: mean intracranial pressure >15mmHg, or B-waves present in >10% of overnight recording; pressure-volume index <15ml, or resistance to cerebrospinal fluid outflow (ROUT) >4.5mmHg/ml/min in bolus infusion test; ROUT>12mmHg/ml/min, intracranial pressure >22mmHg, or high amplitude B-waves in the steady-state of the continuous rate infusion test; or a clinical response to high-volume cerebrospinal fluid withdrawal.
  
  
  CONCLUSIONS
  The implementation of a diagnostic and therapeutic protocol for idiopathic normal pressure hydrocephalus management could improve various aspects of patient care. It could reduce variability in clinical practice, optimise the use of health resources, and help in identifying scientific uncertainty areas, in order to direct research efforts in a more appropriate way.
authors.affiliation: Servicio de Neurocirugía-Unidad de Raquis Quirúrgico, Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria; Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Santander, Cantabria; Observatorio de Salud Pública de Cantabria, Fundación Marqués de Valdecilla, Santander, Cantabria. Electronic address: rmlaez@yahoo.es.
authors.forename: Rubén
authors.initials: R
authors.lastname: Martín-Láez
authors.affiliation: Servicio de Neurocirugía-Unidad de Raquis Quirúrgico, Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria; Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Santander, Cantabria; Observatorio de Salud Pública de Cantabria, Fundación Marqués de Valdecilla, Santander, Cantabria.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vázquez-Barquero
mesh_terms: D000328:Adult; D000368:Aged; D015170:Cerebrospinal Fluid Pressure; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D019028:Magnetic Resonance Imaging, Cine; D008365:Manometry / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D059906:Neuroimaging; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011379:Prognosis; D013030:Spain / Q000453:epidemiology; D013129:Spinal Puncture; D014563:Urodynamics; D017287:Ventriculoperitoneal Shunt
keywords: Cine magnetic resonance imaging; Derivación ventrículo-peritoneal; Hidrocefalia crónica del adulto; Infusion test; Intracranial pressure; Neuro-psychological test; Normal pressure hydrocephalus; Presión intracraneal; Punción lumbar evacuadora; Resonancia magnética; Tap test; Test de infusión; Test neuropsicológicos; Urodinámica; Urodynamics; Ventriculoperitoneal shunt