What are the indications for considering shunt surgery in patients diagnosed with Normal Pressure Hydrocephalus?

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 and 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 and Unterberg, 2012). Neuroimaging findings, such as enlarged ventricles disproportionate to sulcal atrophy, also support the diagnosis and consideration for shunting (Kiefer and 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 and Unterberg, 2012).