Abstract
Background
Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that may be reversible
by diversion of cerebrospinal fluid (CSF). It is increasingly recognized, and accordingly
rates of CSF diversion are increasing despite the absence of level I evidence of efficacy,
non-neglible rate of complications and an unclear natural history.
Methods
A total of 349 neurosurgeons, neurologists, geriatricians and neuropsychiatrists rated
the perceived efficacy of CSF diversion, the duration of effect of CSF diversion,
and the risk-benefit ratio of CSF diversion in iNPH. These physicians then rated the
need for a randomized controlled trial (RCT) of CSF diversion in iNPH. Participants
detailed their desired selection criteria and supportive testing for a RCT, and their
preferred control group.
Results
Physicians believe that there is uncertain efficacy of CSF diversion in iNPH, as well
as the expected duration of this benefit and the risk-benefit ratio for patients.
The greatest degree of uncertainty related to the long-term benefit of surgery. Accordingly,
over 75% desire a RCT to determine the efficacy of CSF diversion in iNPH. Only 2.7%
of participants believe a RCT of CSF diversion in iNPH is unethical. Patients without
a shunt and a programmable valve in the ‘off’ setting were the preferred control groups.
Conclusion
A RCT of CSF diversion in iNPH is absent from the literature. The majority (>75%) of physicians involved in the diagnosis and treatment of iNPH believe a RCT is
required to determine the efficacy, duration of efficacy and risk-benefit ratio of
CSF diversion in iNPH.
Keywords
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Article info
Publication history
Published online: September 06, 2013
Accepted:
June 19,
2013
Received in revised form:
May 14,
2013
Received:
February 9,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
