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Abstract

This chart review study represents the first community-based survey of normal pressure hydrocephalus treatment results published with a follow-up of at least 3 years. The study evaluated all citizens of Olmsted County (MN, USA), where the Mayo Clinic is the only provider of neuro surgical services, from 1995 to 2003. The authors noted that Olmsted doctors had a “high level of vigilance” for this diagnosis. The important numbers to take away from this review are: of the 38 who had high volume lumbar puncture 14 had gait improvement and 13 were shunted, for a yearly rate of 4.82 out of 100,000 in those over 50 years of age; the mean age at shunting was 78.5 years; nine out of 12 with a 3 to 6 month follow-up had definite gait improvement, dropping to six out of 12 at 1 year and four out of 12 at year 3. Adverse events affected 33%, including death, seizures and subdural hematoma. This paper did not review technical issues related to shunting, and one can wonder if technical advances in valves or use of lumbar drainage may have produced fewer side effects or improved outcomes. Normal pressure hydrocephalus should be considered a rare diagnosis without a favorable benefit to risk ratio for its treatment.