Shunt Surgery Beneficial in Idiopathic Normal-Pressure Hydrocephalus
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TUESDAY, Sept. 23, 2025 -- Shunt surgery significantly improves gait velocity at three months among patients with idiopathic normal-pressure hydrocephalus with a response to temporary cerebrospinal fluid (CSF) drainage, according to a study published online Sept. 16 in the New England Journal of Medicine to coincide with the annual meeting of the American Neurological Association, held Sept. 13 to 16 in Baltimore.
Mark G. Luciano, M.D., Ph.D., from Johns Hopkins University in Baltimore, and colleagues conducted a double-blind, randomized trial involving 99 patients selected for shunt surgery on the basis of gait-velocity improvement with CSF drainage. Participants were randomly assigned to an open-shunt valve setting or placebo valve setting (opening pressure, 110 and >400 mm of water, respectively).
The researchers found that gait velocity had increased in the open-shunt group and was unchanged in the placebo group at three months (mean change, 0.23 ± 0.23 and 0.03 ± 0.23 m/s), resulting in a treatment difference of 0.21 m/s. For the Tinetti scale score, significantly greater improvement was seen in the open-shunt versus placebo group (mean change, 2.9 versus 0.5 points), but this finding was not seen for the Montreal Cognitive Assessment score (1.3 versus 0.3 points) or the Overactive Bladder Questionnaire score (−3.3 versus −1.5 points). Regarding adverse events, the results were mixed, with more participants in the placebo group reporting falls, an equal percentage having cerebral bleeding, and more participants in the open-shunt group with subdural bleeding and positional headaches.
"This study shows surgery is both effective and has an acceptable safety profile. We've proven this treatment works, definitively and safely, in the most rigorous type of study possible," Luciano said in a statement.
Several authors disclosed ties to the medical device industry; several authors hold patents.
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