• Fernando Campos Gomes Pinto, Felippe Saad, Matheus Fernandes de Oliveira, Renan Muralho Pereira, Fernanda Letkaske de Miranda, Juliana Benevenuto Tornai, Maria Izabel Romão Lopes, Eduardo Santamaria Carvalhal Ribas, Emilia Aparecida Valinetti, and Manoel Jacobsen Teixeira.
• Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
• Neurosurgery. 2013 May 1;72(5):845-53; discussion 853-4.

BackgroundCurrently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation.ObjectiveTo compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS.MethodsRandomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus.ResultsThere was a statistically significant difference between the 2 groups after 12 months of follow-ups, and the VPS group showed better improvement results (ETV = 50%, VPS = 76.9%).ConclusionCompared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.

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