• Rui Yin, Jianbo Chang, Xiao Zhang, Caiyan Liu, Jing Gao, Junxian Wen, Yihao Chen, Lang Yang, Xiying Dong, Feng Feng, Hui You, Wei Zuo, and Junji Wei.
• Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
• World Neurosurg. 2023 Feb 1; 170: e364e370e364-e370.

ObjectiveDifferentiating idiopathic normal pressure hydrocephalus (iNPH) from other neurodegenerative diseases is challenging. Only a portion of the patients clinically suspected of iNPH would respond to surgical intervention. A cerebrospinal fluid (CSF) tap test is usually used to predict surgery outcomes and hence aid clinical decision-making, but the workup varies. We introduce the CSF tap test conducted at our center and examine its power by analyzing data from a series of iNPH cases that underwent shunt placement. We analyze common features in the past medical history of our patients and investigate whether they are related to the etiology of iNPH.MethodsData from 20 patients who were positive in the tap tests preoperatively and received ventriculoperitoneal shunting (VPS) were retrospectively analyzed. Preoperative and postoperative performance data were analyzed. History of any underlying medical conditions was taken into consideration. Patients with negative tap test results of the same period were also followed up.ResultsWe performed VPS placement in 20 NPH patients from October 2019 to February 2022. Of these, 90% exhibited improvement in at least 1 of the clinical triad, proving the predictive power of the Peking Union Medical College Hospital test workflow. The underlying conditions like hypertension, diabetes and insufficiency in cerebral blood supply were also found to be associated with the onset of NPH.ConclusionOur evaluation system is a valid tool for NPH assessment and can guide clinical decision-making. Comorbidities should be taken into consideration as they contribute to the pathogenesis and progression of NPH. Better identification of potential iNPH patients will lower the burden exerted on the family and the aging society.Copyright © 2022 Elsevier Inc. All rights reserved.

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