• W K Pfisterer, F Aboul-Enein, E Gebhart, M Graf, M Aichholzer, and M Mühlbauer.
• Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria. wolfgang.pfisterer@wienkav.at
• Acta Neurochir (Wien). 2007 Oct 1; 149 (10): 983-90; discussion 990.

ObjectivesNormal-pressure hydrocephalus (NPH) syndrome is treatable by implantation of a cerebrospinal fluid (CSF) shunt. However, diagnosis of NPH by clinical and radiological findings alone is unreliable, and co-existing structural dementia can contribute to low success rates after shunt implantation. The aim of our study was to investigate whether long-term results after shunt implantation in NPH improve when surgical candidates are selected by continuous intraventricular pressure monitoring (CIPM).Patients And MethodsNinety-two consecutive patients who were admitted with suspected NPH received CIPM for 48 h including an intraventricular steady-state infusion test to determine the resistance outflow. With positive CIPM, shunt implantation was performed and the patients were prospectively followed up for 1 to 10 years (median 6.5 years).ResultsCIPM was negative in 37 patients. Fifty-five patients had a positive CIPM and received CSF shunt. 96.1% of them improved from gait disturbance, 77.1% from cognitive impairment and 75.7% from urinary dysfunction. Clinical improvement remained during long-term follow-up in all but 3 patients who showed a decline at 4, 5 and 7 years, respectively. CIPM-related complications (ventriculitis) occurred in only one patient.ConclusionCIPM is a safe and valuable tool to establish a reliable diagnosis of NPH and to identify promising surgical candidates.

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