The provided UK guidelines (NG228, NG232, CG148, CKS) do not specifically detail indications for considering shunt surgery in patients diagnosed with normal pressure hydrocephalus (NPH).
However, current literature indicates that shunt surgery is considered for patients with NPH who present with the classic triad of symptoms: gait disturbance, cognitive impairment, and urinary incontinence Kiefer & Unterberg 2012. A positive response to a cerebrospinal fluid (CSF) tap test, where symptoms transiently improve after removal of a certain volume of CSF, is a strong indicator for potential benefit from shunt surgery Kiefer & Unterberg 2012. Neuroimaging findings, such as enlarged ventricles disproportionate to sulcal atrophy, also support the diagnosis and consideration for shunting Kiefer & Unterberg 2012. Patient selection for shunt surgery in NPH requires careful consideration of the clinical presentation and diagnostic test results to predict a favourable outcome Kiefer & Unterberg 2012.
Key References
- NG228 - Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management
- NG232 - Head injury: assessment and early management
- CG148 - Urinary incontinence in neurological disease: assessment and management
- CKS - Scrotal pain and swelling
- (Kiefer and Unterberg, 2012): The differential diagnosis and treatment of normal-pressure hydrocephalus.