NPH Etiology and Updated CSF Management

Normal pressure hydrocephalus (NPH) is a progressive neurological disease that requires early diagnosis for better treatment. Understanding its pathophysiology, particularly cerebrospinal fluid (CSF) pulsatility, aids in patient selection for shunt surgery. NPH is characterized by a triad of clinical symptoms that can be assessed or quantified. Diagnosis of NPH depends upon the pattern of clinical features, various invasive tests, and radiological investigations. Shunt surgery remains the mainstay of treatment of NPH. Several variations to traditional ventriculoperitoneal (VP) shunt surgery, including ventriculoatrial (VA), lumboperitoneal (LP), and programmable shunts, are performed with possibly better results. Recently, the role of endoscopic third ventriculostomy (ETV) has also been proposed as an alternative to shunt surgery in patients with NPH.